Ivabradine in practice

Abstract

Ivabradine is an innovation in the cardiovascular fraternity with specific heart rate-lowering property, which expresses selective action on pacemaker activity in the sinoatrial node of the heart, resulting into important clinical benefits for improvement in coronary perfusion and pump efficiency. Ivabradine demonstrated substantial antianginal and anti-ischemic efficacy, improvement in exercise capacity and in quality of life in monotherapy or in combination with beta-blockers. The analysis of pooled data from ivabradine angina development programme assessing the antianginal efficacy of ivabradine across several different subgroups provided clinical evidence that ivabradine diminishes angina in all types of patients, whatever their age, sex, severity of angina, and revascularization status, history of previous myocardial infarction, peripheral vascular disease, or diabetes. These clinical benefits make ivabradine an important agent for symptomatic treatment of patients with angina pectoris. The important role of ivabradine in the management of patients with chronic heart failure (HF) is well established and supported by its benefits in prevention of morbidity and mortality demonstrated in SHIFT trial. Efficacy and tolerability of ivabradine in patients with HF, including those with different clinical profiles (elderly; severe disease; low blood pressure; comorbidities, including renal dysfunction, diabetes, chronic obstructive pulmonary disease), make ivabradine particularly pertinent for achievement of all targets in the treatment of HF, including improvement of symptoms and well-being, as well as outcomes. The available wealth of evidence supports the important place of ivabradine as an essential therapeutic modality to enhance the management of patients with angina or chronic HF.