The Role of Ivabradine in Cardiac Rehabilitation in Patients With Recent Coronary Artery Bypass Graft

Marazìa, Stefania; Urso, L.; Contini, Marco; Pano, Marco; Zaccaria, Salvatore; Lenti, Vincenzo; Sarullo, Filippo M.; Mauro, Michele Di

doi:10.1177/1074248415575963

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…These findings correspond with a meta-analysis of 41 trials of people with CHD and heart failure which found a pooled MD of 3.3 ml/kg/min for VO 2 in favour of CR32 (corresponding to ~1.0 METs). It would take a typically deconditioned cardiac patient with AF with a peak VO 2 value of ~13 ml/kg / min to a value >14 ml/kg/min 33 34. This is clinically meaningful as it would reduce the mortality and morbidity risk of such a patient35 and represents an absolute change of 4%–5% which would be noticeable in terms of associated symptoms, for example, dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

et al. 2018

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ObjectiveThe aim of this study was to undertake a contemporary review of the impact of exercise-based cardiac rehabilitation (CR) targeted at patients with atrial fibrillation (AF).MethodsWe conducted searches of PubMED, EMBASE and the Cochrane Library of Controlled Trials (up until 30 November 2017) using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a no exercise or usual care control group. Meta-analyses of outcomes were conducted where appropriate.ResultsThe nine randomised trials included 959 (483 exercise-based CR vs 476 controls) patients with various types of AF. Compared with control, pooled analysis showed no difference in all-cause mortality (risk ratio (RR) 1.08, 95% CI 0.77 to 1.53, p=0.64) following exercise-based CR. However, there were improvements in health-related quality of life (mean SF-36 mental component score (MCS): 4.00, 95% CI 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min, 95% CI 0.11 to 3.08; p=0.04; mean 6 min walk test: 46.9 m, 95% CI 26.4 to 67.4; p<0.001) with exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.ConclusionsExercise capacity, cardiac function, symptom burden and health-related quality of life were improved with exercise-based CR in the short term (up to 6 months) targeted at patients with AF. However, high-quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes (including health-related quality of life, mortality, hospitalisation and costs) and how these effects may vary across AF subtypes.

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Section: Discussionmentioning

confidence: 99%

Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

et al. 2018

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“…Once CVR has been initiated and adequate adherence has been achieved, some patients may require dose reduction or even discontinuation of some drugs due to adaptations to physical training, e.g., patients who develop hypotension, marked bradycardia, or symptomatic hypoglycemia. 74,75…”

Section: Integration Of Cardiovascular Rehabilitation Into Optimized mentioning

confidence: 99%

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

Carvalho¹,

Milani²,

Ferraz³

et al. 2020

Arquivos Brasileiros De Cardiologia

116

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“…Results indicated a significant improvement in LVEF within the combination group, escalating from 57% ± 3% at admission to 62% ± 4% at discharge, and reaching 66% ± 3% at three months. Conversely, LVEF remained relatively stable in the bisoprolol group, documented at 57% ± 3% at admission, 59% ± 4% at discharge, and 59% ± 3% at three months [16] .…”

Section: Discussionmentioning

confidence: 87%

Postoperative Atrial Fibrillation Prevention in Patients Undergoing Coronary Artery Bypass Grafting by Using Perioperative HCN Channel Blockers and Selective Beta Blockers

2024

The Egyptian Journal of Hospital Medicine

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Background: Postoperative atrial fibrillation (AF) is commonly occurring following coronary artery bypass graft (CABG) surgery. Controversies are present regarding the superior medications that prevent AF. Objective: To evaluate the efficacy of the perioperative use of bisoprolol and ivabradine versus bisoprolol alone as a prophylactic treatment in the prevention of postoperative AF in patients underwent elective CABG surgery. Patients and Methods: This is a prospective interventional study included 50 adult patients who underwent elective CABG surgery. Patients were assessed for eligibility from Department of Cardiothoracic Surgery in Benha University Hospitals. Patients were randomly divided into two equal groups; Group I received both ivabradine (Procoralan®) and Bisoprolol (Concor®) and Group II received bisoprolol (Concor®) only. Both groups received their treatments 48 hours before surgery and continued one week postoperatively. Ethical approval and informed written consents were obtained. Results: Postoperative prevention of postoperative atrial fibrillation in the combination therapy (Ivabradine plus bisoprolol) (group I) was more effective than bisoprolol given alone (group II). There was a statistically significant increase in the overall postoperative atrial fibrillation among patients in group II compared with group I (36% vs. 4%, respectively, P value=0.01). Conclusion:Ivabradine is a safe and effective drug to be administered along with a beta blocker (Bisoprolol) perioperatively in patients undergoing CABG surgery in terms of reducing heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), intensive care unit (ICU) stay, and better postoperative echocardiographic data and significantly reducing the incidence of the overall postoperative atrial fibrillation.

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The Role of Ivabradine in Cardiac Rehabilitation in Patients With Recent Coronary Artery Bypass Graft

Abstract: Adding ivabradine to low-dose bisoprolol during cardiac rehabilitation in patients with CABG improved functional capacity, enhanced recovery of systolic function, and reduced diastolic dysfunction.

Cited by 8 publications

References 29 publications

Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

Postoperative Atrial Fibrillation Prevention in Patients Undergoing Coronary Artery Bypass Grafting by Using Perioperative HCN Channel Blockers and Selective Beta Blockers

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