Ivabradine alone and in combination with metoprolol reduces the incidence of major adverse cardiac events in patients with heart failure: A prospective study

Abstract

Background: Altered hemodynamics of heart failure patients is associated with an increased heart rate (HR). The effect of β-blockers on prognosis has been linked to their HR lowering effect. Ivabradine is an If current inhibitor and it decreases the heart rate. Aims and Objectives: The aim of this study was to compare the efficacy of ivabradine, a combination of ivabradine and metoprolol, with that of metoprolol alone in patients with heart failure. Materials and Methods: This prospective observational study was done in patients with New York Heart Association (NYHA) Class III/IV heart failure over 18 months. Patients were categorized into Group A: Ivabradine (5 mg BD), Group B: Metoprolol (12.5 mg BD), and Group C: Combination of both (5 mg BD and 12.5 mg BD). At the end of 6 months follow-up, the outcomes of therapy were assessed based on the occurrence of major adverse cardiac events (MACE) such as acute coronary syndrome, rehospitalization, or death. Effectiveness was also measured in terms of a decrease in HR, improvement in left ventricular ejection fraction (LVEF), and NYHA functional class. Results: One hundred and fifty-two patients were included in this study in three groups – 51 patients in Group A, 50 patients in Group B, and 51 patients in Group C. At the end of follow-up period, it was found that the highest number of MACE occurred in Group B followed by A and C. Group C showed significant improvement with therapy in terms of decrease in HR, increase in LVEF, and improvement in NYHA class. Conclusion: Administration of ivabradine alone or a combination of ivabradine and metoprolol is more effective than metoprolol in reducing the incidence of MACE in heart failure.