Role of ivabradine in management of stable angina in patients with different clinical profiles

Kaski, Juan Carlos; Gloekler, Steffen; Ferrari, Roberto; Fox, Kim; Lévy, Bernard; Komajda, Michel; Vardas, Panos; Camici, Paolo G.

doi:10.1136/openhrt-2017-000725

Cited by 11 publications

(13 citation statements)

References 61 publications

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“…8)15) The analysis of frequency of angina pectoris episodes compared to ranolazine showed diametrically opposed results in Taccheri et al 17) and Villano et al 19) Overall, there is no convincing evidence for significant advantages of ivabradine compared to other anti-anginal substances. We acknowledge that these results contrast current literature as Kaski et al 25) and Werdan et al, 26) who summarised that ivabradine represents a useful agent for the symptomatic treatment of patients with angina pectoris, even in relation to different subgroups as monotherapy, combination therapy, elderly, comorbidities, revascularisation and CAD without heart failure 25) as well as CCS classification, medical history and medication. 26) Their statements should be interpreted with caution as these reviews refer not only to RCTs but mainly to observational studies.…”

Section: Discussioncontrasting

confidence: 94%

“…24) This conclusion is also supported by the consensus statement of Ferrari et al 30) emphasising the synergistic effects of beta-blockers and ivabradine. In contrast to Kaski et al 25) and Werdan et al, 26) latter draws its statements from RCTs 7) 8) 11) 12) 27) 29) demonstrating—similar to the data which current guidelines 1) 2) 3) are based—that there is a great lack of randomised, double-blind, investigator-initiated studies with patient-centred, functional outcomes in an adequately large patient population.…”

Section: Discussionmentioning

confidence: 94%

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Ivabradine for the Therapy of Chronic Stable Angina Pectoris: a Systematic Review and Meta-Analysis

et al. 2020

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Background and Objectives Coronary artery disease (CAD) is the number one cause of death worldwide. The I f channel inhibitor ivabradine serves as second line medication for the CAD leading symptom angina pectoris. This systematic review and meta-analysis assess the existing evidence of ivabradine in angina pectoris. Methods We systematically searched MEDLINE, Embase, CENTRAL, and Web of Science (September 2019) for randomized controlled trials (RCTs) that compared ivabradine versus placebo, standard therapy (ST) or other anti-anginal drugs. Two review authors independently assessed trials for inclusion and performed data extraction. We completed a ‘risk of bias’ assessment for all studies and assessed quality of the trial evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. We meta-analysed data were applicable and calculated mean differences (MDs) and risk ratios using a random-effects model. Results A total of 11 RCTs (n=16,039) were included. Compared to placebo/ST, we found significant effects on the frequency of hospitalisation in a small cohort (n=90; hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.04, −0.92; p=0.04), but no effects on cardiovascular mortality (n=19,102; HR, 1.10; 95% CI, 0.94, 1.28; p=0.25) or the frequency of angina pectoris episodes (n=167; weighted MD, −1.06; 95% CI, −2.74, −0.61; p=0.21). Conclusions The present work makes an important contribution to optimal patient care in angina pectoris by complementing the current European Society of Cardiology guideline—recommending class IIa with evidence level B—decisively with 8 further studies.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Ivabradine for the Therapy of Chronic Stable Angina Pectoris: a Systematic Review and Meta-Analysis

et al. 2020

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“…Ivabradine effectively reduced the HR in patients with HF who were previously on beta-blocker therapy. 51 In patients whose HR was >70 bpm, addition of ivabradine to the beta-blocker was favorable. In the ETHIC-AHF trial, early co-administration of ivabradine and betablockers was found to be beneficial.…”

Section: Role Of Ivabradine In Patients With Stable Angina and Heart Failurementioning

confidence: 99%

Elevated heart rate across cardiovascular continuum and its management

Punjabi

George

Khera³

et al. 2021

Int J Adv Med

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Elevated heart rate in both healthy individuals and patients with coronary artery disease (CAD), acute myocardial infarction (AMI) and heart failure poses a major risk factor for morbidity and mortality. This fact has further been supported by several studies pointing out to elevated resting heart rate as an important marker for this catastrophe necessitating a prompt therapeutic action plan, consisting of early detection and treatment of the risk factors, to achieve ideal heart rates (approximately 60 beats/minute) in patients which could stop or prevent the progression of the cardiovascular disease (CVD) continuum. Lowering heart rate by therapeutic interventions has shown favorable results, but most of the data so far is retrospective and limited to AMI and heart failure with beta-blocker treatment. Addition of newer drugs into the cardiac armamentarium, like ivabradine, a sinus node inhibitor acting by selective heart rate reduction, has shown several beneficial effects in a variety of conditions spanning from stable angina to heart failure. A consensus meeting was held at the national level wherein experts from various parts of the country discussed and reviewed the importance of heart rate lowering across CV continuum and addition of ivabradine for patients with chronic heart failure and chronic stable angina.

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“…Антиангинальная и противоишемическая эффективность селективного ингибитора If-каналов ивабрадина установлена у пациентов со СС в монотерапии и в комбинации с другими антиангинальными препаратами, включая БАБ [16,17]. Результаты исследования BEAUTIFUL [2] показали, что ивабрадин, назначенный в дополнение к стандартной терапии, способствует снижению риска сердечно-сосудистых событий у больных со стабильной ИБС и сердечной недостаточностью с низкой фракцией выброса [2], особенно у больных с исходной ЧСС >70 уд / мин и у пациентов с сохраняющимися приступами стенокардии [18].…”

Section: результатыunclassified

New opportunities to improve the treatment effectiveness of patients with stable angina

et al. 2020

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Aim To study the antianginal and heart rate slowing effects in patients with stable angina (SA) who failed to achieve the heart rate (HR) goal and were switched from the beta-blocker (BB) metoprolol tartrate to a combination of metoprolol tartrate and ivabradine.Materials and methods The study included 54 patients with SA not higher than functional class (FC) III (35 (64.8 %) men and 19 (35.2 %) women) aged 59 [48; 77] years. Prior to the study start and at 4 and 8 weeks of follow-up, electrocardiography (ECG) and 24-h ECG monitoring (24h-ECGM) were performed for all patients. The follow-up period duration was 8 weeks. The antianginal and heart rate slowing effects of therapy were clinically evaluated by a decrease in frequency of anginal attacks and patients’ requirement for nitrates, a decrease in HR, and the effect on 24h-ECGM indexes characterizing myocardial ischemia. At the first stage, all patients were prescribed metoprolol tartrate (Egilok®, Egis, Hungary) 25 mg twice a day. Patients with resting HR still higher than 70 bpm after 4 weeks of treatment were switched from metoprolol tartrate to a fixed ivabradine/metoprolol combination (Implicor®, Servier, France) 5 / 25 mg twice a day. Thus, based on achieving/ non-achieving the HR goal, two groups of patients were formed. Statistical analysis was performed with a STATISTICA 10,0 software package.Results After 4 weeks of therapy with metoprolol tartrate 25 mg twice a day, 18 (33.3%) patients of group 1 achieved the HR goal of 70 bpm, while 36 (66.7%) patients of group 2 did not achieve the goal. For further correction of HR, patients of group 2 were switched from metoprolol tartrate to ivabradine/metoprolol 5 / 25 mg twice a day. After 4 weeks of the ivabradine/metoprolol treatment, 31 (86.1 %) patients achieved the HR goal with median resting HR of 62 [56; 70] bpm. The number of angina attacks decreased from 6 [3; 8] to 2 [1; 3] per week (р<0.001). 24hECGM showed that the mean diurnal HR decreased from 81 [76; 96] to 66 [56; 76] bpm (р<0.001); mean night HR decreased from 69 [73; 80] to 52 [43; 60] bpm (р=0.012); and the ischemic ST segment depression was absent.Conclusion Only 33.3% of patients with stable angina achieved the HR goal on metoprolol tartrate 25 mg twice a day. Supplementing the beta-blocker metoprolol tartrate at the same dose with ivabradine allowed 86.1% of patients to achieve the HR goal and exerted a pronounced anti-anginal effect.

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Role of ivabradine in management of stable angina in patients with different clinical profiles

Cited by 11 publications

References 61 publications

Ivabradine for the Therapy of Chronic Stable Angina Pectoris: a Systematic Review and Meta-Analysis

Ivabradine for the Therapy of Chronic Stable Angina Pectoris: a Systematic Review and Meta-Analysis

Elevated heart rate across cardiovascular continuum and its management

New opportunities to improve the treatment effectiveness of patients with stable angina

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