Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial

Fox, Kim; Ford, Ian; Steg, Philippe Gabriel; Tendera, Michał; Robertson, Michele; Ferrari, Roberto

doi:10.1016/s0140-6736(08)61171-x

Cited by 709 publications

(551 citation statements)

References 20 publications

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“…• The BEAUTIFUL trial 56,57 assessed the effects of ivabradine on clinical outcomes. The primary end point (combination of cardiovascular death and hospitalization for myocardial infarction or for new-onset or worsening heart failure) was not improved by ivabradine.…”

Section: Key Points For Ivabradinementioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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Chronic stable angina pectoris is the most prevalent symptomatic manifestation of ischaemic heart disease, and its management is a priority (BOX 1). Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revasculariza tion [1][2][3][4] . However, revascularization by either percutaneous coronary angioplasty or CABG surgery is indicated in patients who have significant artery steno sis (50% left main narrowing or proximal three-vessel disease) to reduce myocardial ischaemia and its adverse clinical manifestation. Antianginal agents are approved by documenting that they improve total exercise duration, together with a reduction in daily frequency of chronic stable angina compared with placebo and/or equivalence to an active comparator. Cardiovascular outcomes, although highly advocated, are not a pre requisite for regulatory approval. None of the antianginal drugs has been proved to reduce cardiovascular mortality or the rate of myocardial infarction. When patients are optimally treated, mortality for chronic stable angina is low, which might explain why all trials designed to improve prognosis have been negative. Guidelines recom mend a first-choice and a second-choice approach, based more on tradition and expert opinion, rather than evidence. This categorical approach has been questioned in the past couple of years 5-8 . Newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than is available for the traditional first-choice drugs. Equally, the often-needed combin ation of double or triple therapy is based on expert opinion and not related to the underlying pathophysio logy. What constitutes optimal antianginal treatment, therefore, varies considerably between countries, and the majority of doctors treat their patients according to their own preconceptions.A group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy, to discuss an individualized approach to medical treatment of chronic stable angina, on the basis E X P E RT C O N S E N S U S D O C U M E N TA 'diamond' approach to personalized treatment of angina Abstract | In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for tr...

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Section: Key Points For Ivabradinementioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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“…Relatively high resting heart rate is an indication of inadequate HF control, and is an independent predictor of cardiovascular (CV)-related morbidity (hospitalizations) and mortality in patients with left ventricular systolic dysfunction and chronic symptomatic HF (6)(7)(8)(9)(10). In April, 2015, the US Food and Drug Administration approved ivabradine to reduce the risk of hospitalization for worsening of HF in patients with stable, symptomatic, chronic HF with left ventricular ejection fraction (LVEF) ≤ 35%, who are in sinus rhythm with a resting heart rate ≥ 70 beats per minute (bpm), and either are receiving maximally tolerated doses of or have a contraindication to beta-blockers.…”

Section: Introductionmentioning

confidence: 99%

Budget Impact of Adding Ivabradine to Standard of Care in Patients with Chronic Systolic Heart Failure in the United States

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Kansal

Dorman³

et al. 2016

JMCP

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“…3 Attenuation of raised heart rate is one benefit of treatment with a beta-blocker. 4 The technology Ivabradine (Procoralan) is an inhibitor of the sinus node I f current that controls spontaneous diastolic depolarisation and regulates heart rate.…”

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confidence: 99%