Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction

Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana; Francis, Jane M; Dwight, Jeremy; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael; Ashrafian, Houman

doi:10.1161/circulationaha.115.017119

Cited by 125 publications

(85 citation statements)

References 44 publications

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“…18 In our study, the use of ivabradine was associated with a reduction in heart rate and significant improvement of modified Borg scale and 6-minute walk distance. In another study, Pal et al 19 found that heart rate reduction with ivabradine was not associated with an improvement in exercise capacity. That study included different categories of patients; namely heart failure with preserved ejection fraction (HFpEF) and asymptomatic hypertensives.…”

Section: Discussionmentioning

confidence: 94%

The effect of ivabradine on functional capacity in patients with chronic obstructive pulmonary disease

et al. 2016

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Increased sympathetic tone and use of bronchodilators increase heart rate and this may worsen functional capacity in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to look at the short-term effect of the heart rate lowering drug ivabradine on clinical status in COPD patients. We randomised 80 COPD patients with sinus heart rate ≥90 bpm into either taking ivabradine 7.5 mg twice per day or placebo for two weeks. We assessed all patients using the modifi ed Borg scale and 6-minute walk test at baseline and then again 2 weeks after randomisation. There were no signifi cant differences in age, sex, severity of airway obstruction (measured using forceful exhalation), severity of diastolic dysfunction or pulmonary artery systolic pressure between the two groups. The ivabradine group showed signifi cant improvement in 6-minute walk distance (from 192.6±108.8 m at baseline to 285.1±88.9 m at the end of the study) compared with the control group (230.6±68.4 at baseline and 250.4±65.8 m at the end of study) (p<0.001). This improvement in the drug group was associated with signifi cant improvement of dyspnea on modifi ed Borg scale (p=0.007). Lowering heart rate with ivabradine can improve exercise capacity and functional class in COPD patients with resting heart rate >90 bpm.

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Section: Discussionmentioning

confidence: 94%

The effect of ivabradine on functional capacity in patients with chronic obstructive pulmonary disease

et al. 2016

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“…61 The second study administered ivabradine 7.5 mg twice daily in a crossover design to 22 patients with HFpEF. 62 Although ivabradine improved echocardiographic parameters of diastolic function over 2 weeks, it diminished peak oxygen consumption and submaximal exercise performance measured by oxygen uptake efficiency slope.…”

Section: Hf With Preserved Ejection Fractionmentioning

confidence: 96%

“…HR decreased ≈10 bpm in the low-dose trial compared with 20 bpm in the higher-dose trial. 61,62 Given the heterogeneity of HFpEF diagnoses, additional uncharacterized differences in the subjects were likely. 63 More evidence is needed to determine the potential role for ivabradine in patients with HFpEF.…”

Section: Hf With Preserved Ejection Fractionmentioning

confidence: 99%

Ivabradine

Psotka

Teerlink

2016

Circulation

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Abstract-Ivabradine is approved to reduce hospitalizations for patients with symptomatic heart failure, reduced ejection fraction, and persistently elevated heart rate despite otherwise maximal medical therapy. However, the eligible patient population is a small fraction of those with heart failure overall. This review summarizes the major clinical evidence supporting the use of ivabradine, identifies and discusses areas of uncertainty from the clinical trial data, helps describe the population most likely to benefit, and attempts to place ivabradine within the multifaceted treatment scheme currently used for patients with heart failure and reduced ejection fraction.

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“…Because many HFpEF patients only show HF symptoms during exercise, ivabradine treatment may be beneficial in HFpEF patients. However, a randomized crossover study [84] examined the effect of ivabradine treatment on exercise capacity in 22 symptomatic HFpEF patients with objective evidence of exercise limitation compared to placebo. Study results were compared with 22 similarly treated matched asymptomatic hypertensive volunteers.…”

Section: Ivabradinementioning

confidence: 99%

New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations

Screever

Meijers

Veldhuisen

et al. 2017

Expert Opinion on Pharmacotherapy

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Introduction: Heart failure (HF) remains a major public health problem worldwide, affecting approximately 23 million patients, and is predominantly a disease of the elderly population. Elderly patients mostly suffer from HF with preserved ejection fraction (HFpEF), which often presents with multiple comorbidities and they require multiple medical treatments. This, together with the heterogeneous phenotype of HFpEF, makes it a difficult syndrome to diagnose and treat. Areas covered: Although HF is most abundant in the elderly, this group is still underrepresented in clinical trials, which results in the lack of evidence-based medical regimens. The current review has focused on new potential therapies for this poorly studied population. The focus will be on several classes of drugs currently recommended or might be expected soon. These will include sacubitril/ valsartan (former LCZ696), Omecamtiv mecarbil, Vericiguat, Ivabradine, mineralocorticoid receptor antagonists (MRAs) and potassium binders. Expert opinion: We discuss promising new treatments and hypothesize that personalized approaches will be needed to treat elderly patients optimally. Medical doctors should not only focus on HF therapy, but comorbidities and polypharmacy should also influence therapeutic decision making. Furthermore, the importance of quality of life as a management endpoint should not be underestimated in the frail elderly. ARTICLE HISTORY

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Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction

Abstract: Supplemental Digital Content is available in the text.

Cited by 125 publications

References 44 publications

The effect of ivabradine on functional capacity in patients with chronic obstructive pulmonary disease

The effect of ivabradine on functional capacity in patients with chronic obstructive pulmonary disease

Ivabradine

New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations

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