Abstract
Heart failure (HF) is an epidemic of cardiovascular disease resulting in impaired function and worsened quality of life (QOL) of HF patients. Increased heart rate correlates with poor outcomes in these patients; therefore, its reduction may be beneficial in reducing hospitalization for worsening HF. Guideline therapy recommendation for β-blocking agents is a standard cornerstone for the treatment of HF. Despite, the dose adjustment of β-blockers for patients who cannot withstand the target dose, desired goal heart rate reduction is unfortunately not always reached. Additionally, β-blockers are contraindicated for certain patients. Ivabradine decreases the heart rate through inhibiting the cardiac pacemaker current (If) without having any influence on the sympathetic nervous system. The drug has been approved by the United States Food and Drug Administration in 2015. In 2012, ivabradine use was included in the European Society of Cardiology (ESC) guidelines for the management of HF, to be used alongside β-blockers or as a safer substitute. This short review aimed to discuss the ivabradine use in both reduced and preserved ejection fraction HF patients. Ivabradine was found to be generally tolerable and safe. Efficacy for HF patients with systolic dysfunction has been confirmed, however, in HF patients with diastolic dysfunction, it is yet to be extensively evaluated. Moreover, the role of ivabradine in HF patients with Atrial Fibrillation (AF) is currently under investigation.
Highlights
Despite the medical advances in therapeutic agents developed for controlling Heart failure (HF), it continues to be a global health burden
Of the patients included in the registry, 68.8% of patients had Acute Heart Failure (AHF), while the rest had Chronic heart failure (CHF), and 67.9% of the total patients were males
Ivabradine was approved in 2015 to improve clinical outcomes in HF patients with persistent symptoms of HF, despite maximum tolerated β-blockers doses, with a left ventricular ejection fraction (LVEF) ≤35%, who are in sinus rhythm with a resting heart rate (RHR) of 70 bpm or greater, or have a contraindication to β-blockers use [7]
Summary
Despite the medical advances in therapeutic agents developed for controlling HF, it continues to be a global health burden. Its prevalence is about 1–2% of the adult population in developed countries. The rate is 1-2% of the population with ages less than 55 and reaches 10% for those older than 75 years [5]. Of the patients included in the registry, 68.8% of patients had Acute Heart Failure (AHF), while the rest had Chronic heart failure (CHF), and 67.9% of the total patients were males. Ivabradine was approved in 2015 to improve clinical outcomes in HF patients with persistent symptoms of HF, despite maximum tolerated β-blockers doses, with a left ventricular ejection fraction (LVEF) ≤35%, who are in sinus rhythm with a resting heart rate (RHR) of 70 bpm or greater, or have a contraindication to β-blockers use [7]. Based on two large registries, ivabradine is prescribed in 19.7% and 21.4% of HF patients [8, 9]
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