Ivabradine, a novel medication for treatment of heart failure with reduced ejection fraction

Abstract

Purpose To critically evaluate current literature, review pharmacology, and discuss clinical role of ivabradine for patients with heart failure (HF) with reduced ejection fraction. Data sources A PubMed search was conducted using the search terms ivabradine and HF. All human studies analyzing the use of ivabradine in patients with HF with reduced ejection fraction and prescribing information were evaluated. Conclusions Greater benefit was seen in the prespecified subgroup with heart rate (HR) > 70 beats per minute (bpm) in the BEAUTIFUL study. Therefore, SHIFT examined the effect of ivabradine on patients with higher resting HR, lower ejection fraction, who had been hospitalized for HF within the previous year. A significant difference was found in the composite primary endpoint of cardiovascular death and hospitalizations for worsening HF in patients with HF and left ventricular systolic dysfunction, driven primarily by reduction in hospitalizations for worsening HF. The most common adverse effect was bradycardia. Implications for practice Ivabradine is a safe and effective medication for HR reduction to reduce hospitalizations in patients with stable, symptomatic HF (ejection fraction < 35%), in sinus rhythm, and HR > 70 bpm.

Ivabradine in the Prevention, and Reduction in Size, of Perioperative Myocardial Injury in Patients Undergoing Orthopedic Surgery for Acute Fracture

“…Ivabradine is a first‐in‐class drug that blocks the intracellular aspect of a specific “funny” ion channel in the sinoatrial node with high selectivity. 15 , 16 , 17 This results in less automatic depolarization in the sinoatrial node and therefore reduced heart rate without an effect on blood pressure or left ventricular function. 15 , 18 …”