Abstract
Aim. To evaluate the therapeutic efficacy of a combination of ivabradine and beta-blockers (BAB) in patients with stable angina, initially taking only BAB and not reaching the target heart rate (HR) due to the risk of hypotension.Material and methods. A prospective observational post-registration study was performed at the Research Institute for Complex Issues of Cardiovascular Diseases. The study included 50 patients with stable angina pectoris (diagnosed by coronary angiography in combination with clinical manifestations of angina of functional class II-III according to the Canadian classification) and an initial sinus rhythm with a heart rate of more than 70 beats per minute. These patients have already taken BAB. Heart rate, the number of angina attacks, nitrate intake and quality of life indicators according to the questionnaire were evaluated as criteria for therapeutic efficacy.Results. Taking the study drug in combination with BAB led to a significant decrease the average heart rate at rest by 20%, as well as after a six-minute walk test (TLC) in most patients (p<0.050), and a decrease in the total number of angina attacks per week from 5 to less than 1 (p<0.050) and the frequency of nitrate intake for the relief of angina attacks from 58% to 20% (p=0.001). Therapy with ivabradine (Bravadin) was well tolerated by patients: there were no adverse events in the observed sample of patients, patients had a high adherence to treatment (100% of the contents of handed out blisters were used). During the 3 months of follow-up, according to the EQ-5D-5L quality of life questionnaire, patients improved their perception of their own health level (p<0.050), the number of patients experiencing mild (p=0.034) and strong (p=0.041) mobility limitations decreased; strong (p=0.024) restriction in self-care, mild (p=0.041) and strong (p=0.024) restriction of daily activities, mild manifestation of pain (p=0.009) and mild anxiety (p=0.027) also were reduced compared with the initial questionnaires.Conclusion. Ivabradine (Bravadin) in addition to BAB is an effective and safe antianginal therapy for the prevention of angina attacks by reducing the initially high heart rate in patients with angina pectoris of functional class II-III.
Highlights
Taking the study drug in combination with BAB led to a significant decrease the average heart rate at rest by 20%, as well as after a six-minute walk test (TLC) in most patients (p
ĐŠĐ”Đ»Ń ĐœĐ°ŃŃĐŸŃŃĐ”ĐłĐŸ ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžŃ â ОзŃŃĐžŃŃ ĐžĐ·ĐŒĐ”ĐœĐ”ĐœĐžŃ ŃŃĐŸĐČĐœŃ ŃĐ°ŃŃĐŸŃŃ ŃĐ”ŃĐŽĐ”ŃĐœŃŃ ŃĐŸĐșŃĐ°ŃĐ”ĐœĐžĐč (ЧХХ), ĐșĐŸĐ»ĐžŃĐ”ŃŃĐČĐ° ĐżŃĐžŃŃŃĐżĐŸĐČ ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОО, ĐżĐŸŃŃĐ”Đ±Đ»Đ”ĐœĐžŃ ĐœĐžŃŃĐ°ŃĐŸĐČ Đž ĐșĐ°ŃĐ”ŃŃĐČĐ° Đ¶ĐžĐ·ĐœĐž Ń ĐżĐ°ŃĐžĐ”ĐœŃĐŸĐČ ŃĐŸ ŃŃабОлŃĐœĐŸĐč ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОДĐč ĐœĐ° ŃĐŸĐœĐ” ĐżŃĐžĐ”ĐŒĐ° ĐžĐČабŃĐ°ĐŽĐžĐœĐ° ĐČ ĐșĐŸĐŒĐ±ĐžĐœĐ°ŃОО Ń ĐĐĐ ĐżŃĐž ĐžŃŃ ĐŸĐŽĐœĐŸ ŃĐžĐœŃŃĐŸĐČĐŸĐŒ ŃĐžŃĐŒĐ” Ń Đ§ĐĄĐĄ Đ±ĐŸĐ»Đ”Đ” 70 ŃĐŽ/ĐŒĐžĐœ
Kashtalap â MD, PhD, Head of Laboratory of Pathophysiology of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases; Associate Professor, Chair of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University Olga L
Summary
Đ ŃĐ°Đ±ĐŸŃŃ Đ±ŃлО ĐČĐșĐ»ŃŃĐ”ĐœŃ 50 паŃĐžĐ”ĐœŃĐŸĐČ ŃĐŸ ŃŃабОлŃĐœĐŸĐč ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОДĐč (ĐŽĐžĐ°ĐłĐœĐŸŃŃĐžŃĐŸĐČĐ°ĐœĐœĐŸĐč ĐżĐŸ ŃДзŃĐ»ŃŃĐ°ŃĐ°ĐŒ ĐșĐŸŃĐŸĐœĐ°ŃĐŸĐłŃĐ°ŃОО ĐČ ŃĐŸŃĐ”ŃĐ°ĐœĐžĐž Ń ĐșĐ»ĐžĐœĐžŃĐ”ŃĐșĐžĐŒĐž ĐżŃĐŸŃĐČĐ»Đ”ĐœĐžŃĐŒĐž ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОО ĐœĐ°ĐżŃŃĐ¶Đ”ĐœĐžŃ II-III ŃŃĐœĐșŃĐžĐŸĐœĐ°Đ»ŃĐœĐŸĐłĐŸ ĐșлаŃŃĐŸĐČ ĐżĐŸ ĐĐ°ĐœĐ°ĐŽŃĐșĐŸĐč ĐșлаŃŃĐžŃĐžĐșĐ°ŃОО) ĐœĐ° ŃĐŸĐœĐ” ĐżŃĐžĐ”ĐŒĐ° ĐĐĐ ĐżŃĐž ĐžŃŃ ĐŸĐŽĐœĐŸ ŃĐžĐœŃŃĐŸĐČĐŸĐŒ ŃĐžŃĐŒĐ” Ń Đ§ĐĄĐĄ Đ±ĐŸĐ»Đ”Đ” 70 ŃĐŽ/ĐŒĐžĐœ. ĐĐ°Đ·ĐœĐ°ŃĐ”ĐœĐžĐ” ĐžĐČабŃĐ°ĐŽĐžĐœĐ° (ĐŃĐ°ĐČĐ°ĐŽĐžĐœĐ°) ĐČ ĐŽĐŸĐżĐŸĐ»ĐœĐ”ĐœĐžĐ” Đș ĐĐĐ ŃĐČĐ»ŃĐ”ŃŃŃ ŃŃŃĐ”ĐșŃĐžĐČĐœĐŸĐč Đž Đ±Đ”Đ·ĐŸĐżĐ°ŃĐœĐŸĐč Đ°ĐœŃĐžĐ°ĐœĐłĐžĐœĐ°Đ»ŃĐœĐŸĐč ŃĐ”ŃапОДĐč ĐŽĐ»Ń ĐżŃĐŸŃОлаĐșŃĐžĐșĐž ĐżŃĐžŃŃŃĐżĐŸĐČ ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОО Đ·Đ° ŃŃĐ”Ń ŃĐœĐžĐ¶Đ”ĐœĐžŃ ĐžŃŃ ĐŸĐŽĐœĐŸ ĐČŃŃĐŸĐșĐŸĐč ЧХХ Ń ĐżĐ°ŃĐžĐ”ĐœŃĐŸĐČ ŃĐŸ ŃŃĐ”ĐœĐŸĐșĐ°ŃЎОДĐč II-III ŃŃĐœĐșŃĐžĐŸĐœĐ°Đ»ŃĐœĐŸĐłĐŸ ĐșлаŃŃĐŸĐČ.
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