P222 BENEFITS OF IVRABRADINE IN HEART FAILURE: FROM TRIALS TO CLINICAL PRACTICE

Abstract

Abstract The incidence and prevalence of heart failure (HF) are constantly increasing and represent a fundamental problem for patient hospitalizations and the resulting healthcare costs. In the latest European guidelines the importance of therapeutic optimization in patients suffering from (SCC) has been emphasized to improve prognosis. This was confirmed by the results of the SHIFT trial, aimed at establishing the efficacy of Ivabradine in addition to therapy for the SC. The SHIFT study was performed in symptomatic HF patients with left ventricular systolic dysfunction. Patients were in NYHA class between II and IV and with at least one HF exacerbation hospitalization in the previous year, were randomized to receive Ivabradine at an initial dose of 5 mg twice a day. All patients were treated at the optimal dose of therapy, with ACE–I or Sartani (90%), BB (90%) and MRA (60%). The average follow–up was 24 months. Patients who received ivabradine showed a significant 20% reduction in hospitalization for heart failure exacerbation. These results were also confirmed by the improvement of the clinical picture based on the NYHA classification and the ejection fraction. Also in our clinical practice we found the same result: 6 patients of average age (70–75 years), suffering from HF with severe left ventricular systolic dysfunction (NHYA III), and arterial hypertension in standard therapy optimal for HF according to LG, reach outpatient evaluation for clinical and instrumental follow–up. On check–up, they have dilated heart disease with severe left ventricular systolic dysfunction (FE 35–38%) on the echocardiogram. Therapy with Ivabradine 5 mg x 2 / day was introduced. Upon clinical re–evaluation, after 6 months of therapy, an improvement in the functional class of SC (from NYHA III to NYHA II) and in the ejection fraction (from 38% to 45%) was noted. Conclusions Ivabradine, together with optimal medical therapy for HF, reduced hospitalizations for HF, increased survival and improved patient symptoms, reducing left ventricular remodeling, as confirmed by our clinical practice. Therefore, therapy with Ivabradine, in combination with Beta–Blockers or alone, constitutes a rational and synergistic therapeutic choice for improving the prognosis and quality of life in patients with SCC.