The Effect of Ivabradine on Hospitalization of Heart Failure Patients

Abstract

Background: Ivabradine is recommended in heart failure (HF) patients to reduce cardiovascular death and hospitalization due to worsening of HF symptoms. Aims and Objectives: To study the effect of Ivabradine in addition to guideline-directed medical therapy (GDMT) in a group of HF patients with HR more than 70 bpm, HF with reduced ejection fraction (HFrEF) left ventricular ejection fraction (LVEF ≤ 40%), and New York Heart Association class II-IV. Methods: The study was conducted at Heart Hospital, Hamad Medical Corporation, Qatar. HF patients with age > 18 years, LVEF ≤40%, on GDMT, and HR of ≥70 bpm were included. The study population was divided into two groups: ivabradine group and non-ivabradine group. The primary outcomes were risk, number and length of hospitalizations due to worsening HF, and cardiovascular mortality. The secondary outcome was all-cause mortality. Baseline characteristics were collected at enrollment. Study outcomes were compared in the two groups by applying Chi-square and Fisher's exact tests. Logistic regression model was applied to assess both hospitalizations and cardiovascular mortality. Results: A total of 111 patients were studied, 37 (33.94%) ivabradine group and 74 (66.67%) non-ivabradine group. Risk of hospitalization was lower in Ivabradine group compared to non-Ivabradine group (odds ratio: 0.43, 95% confidence interval [CI]: 0.16–1.015, P = 0.094). Average length of hospitalization in ivabradine and non-ivabradine groups was 12.54 and 8.91 days, respectively (incidence rate ratio [IRR]: 1.63, 95% CI: 0.79–3.38, P = 0.187). Compared to non-ivabradine, ivabradine patients had lower number of hospitalizations (IRR: 1.13, 95% CI: 0.61–2.11, P = 0.694). Death rate in both ivabradine and non-ivabradine groups was 3. Conclusions: Ivabradine along with GDMT reduces the risk of hospitalization due to worsening HF symptoms. Ivabradine had no significant effect on cardiovascular mortality and all-cause mortality. HFrEF non-Arabs patients have lower risk, number and length of hospitalization, and mortality compared to Arabs.

Evaluating the applicability of ivabradine in acute heart failure

“…Compared to the non‐ivabradine group, we observed that the group treated with ivabradine consistently demonstrated improved heart rate changes post‐discharge, with no significant difference in their prognosis. Contrary to previous studies that reported improved outcomes with ivabradine in reducing HHF in the acute setting, 16 , 21 our findings suggest that in real‐world scenarios, ivabradine provides outcomes consistent with standard treatments. Several factors might explain this discrepancy.…”

“…However, the role of ivabradine for this specific group, particularly those who are either intolerant to β‐blockers or cannot further titrate them, remains a topic of debate. While some studies advocate for its efficacy in acute decompensated HF (ADHF) scenarios, others challenge this notion 14–16 . Given the lack of consensus regarding ivabradine use for ADHF, further clinical research is warranted to evaluate its safety and efficacy.…”

“…While some studies advocate for its efficacy in acute decompensated HF (ADHF) scenarios, others challenge this notion. 14 , 15 , 16 Given the lack of consensus regarding ivabradine use for ADHF, further clinical research is warranted to evaluate its safety and efficacy.…”

Ivabradine in patients with heart failure: a systematic literature review

“…Additionally, we conducted a manual search to cover the new findings that were published after the cut-off date for this review. Only two new RCTs [ 76 , 77 ] and three observational studies [ 78–80 ] were relevant for our review criteria. It is worth mentioning that the recently captured clinical trials, FIRST trial (NCT02188082) from China [ 76 ] and another trial (NCT04448899) from Egypt [ 77 ], have reported consistent results with our SLR findings regarding significant heart rate reduction and the non-beneficial impact in reducing HF hospitalization, all-cause hospitalization, and mortality albeit for a small number of analyzed patients.…”

“…It is worth mentioning that the recently captured clinical trials, FIRST trial (NCT02188082) from China [ 76 ] and another trial (NCT04448899) from Egypt [ 77 ], have reported consistent results with our SLR findings regarding significant heart rate reduction and the non-beneficial impact in reducing HF hospitalization, all-cause hospitalization, and mortality albeit for a small number of analyzed patients. The new real-world data analyses conducted in Arab (Qatar) [ 78 ], Taiwan [ 79 ], and China [ 80 ] have demonstrated the beneficial effects of ivabradine in controlling heart rate, but without a clear impact on composite outcomes. Lastly, it is important to highlight that the observational studies included in the review demonstrated a satisfactory level of quality, providing a more robust foundation for analysis and interpretation.…”