Clinical Experience with Ivabradine in Acute Heart Failure

Ivabradine has been shown to improve symptoms and to reduce rehospitalization and mortality in patients with severe chronic heart failure (HF). Its indication in acute HF is not clear. Acute HF patients could also benefit from HR reduction, as myocardial consumption and oxidative stress are related...

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Bibliographic Details
Published inCardiology Vol. 134; no. 3; p. 372
Main Authors Pascual Izco, Marina, Alonso Salinas, Gonzalo Luis, Sanmartín Fernández, Marcelo, Del Castillo Carnevalli, Hugo, Jiménez Mena, Manuel, Camino López, Asunción, Zamorano Gómez, José Luis
Format Journal Article
LanguageEnglish
Published Switzerland 01.01.2016
Subjects
Acute Disease
Aged
Benzazepines - therapeutic use
Blood Pressure
Cardiovascular Agents - therapeutic use
Female
Heart Failure - drug therapy
Heart Failure - physiopathology
Heart Rate
Hospitalization
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
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Summary:Ivabradine has been shown to improve symptoms and to reduce rehospitalization and mortality in patients with severe chronic heart failure (HF). Its indication in acute HF is not clear. Acute HF patients could also benefit from HR reduction, as myocardial consumption and oxidative stress are related to tachycardia. Moreover, beta-blockers are contraindicated in cardiogenic shock and should not be initiated with congestive signs. Accordingly, we evaluated the role of ivabradine in acute HF patients. This was a retrospective analysis of 29 consecutive patients treated for acute HF in the Cardiac ICU, and for whom ivabradine was initiated during hospitalization between January 2011 and January 2014. All patients were in sinus rhythm and had a heart rate (HR) >70 bpm. Catecholamine use was necessary in 16 patients (57.1%) during the hospitalization, in 14 (87.5%) of these before ivabradine treatment. Systolic blood pressure showed no variation during the first 24 h of ivabradine administration or at discharge. HR showed an absolute reduction of 10 bpm at 6 h (p < 0.001), 11 bpm at 24 h (p = 0.004) and 19 bpm (p < 0.001) at discharge. No episodes of significant bradycardia or hypotension were recorded after starting the drug. HR reduction with ivabradine in acute HF is well tolerated. It represents an attractive option, especially when there is excessive catecholamine-related tachycardia; this should be appropriately evaluated in randomized trials.
ISSN:1421-9751
DOI:10.1159/000444845