Premium
Ivabradine: Current and Future Treatment of Heart Failure
Author(s) -
Thorup Lene,
Simonsen Ulf,
Grimm Daniela,
Hedegaard Elise R.
Publication year - 2017
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.12784
Subject(s) - ivabradine , heart failure , medicine , cardiology , bradycardia , ejection fraction , inotrope , heart rate , atrial fibrillation , valsartan , blood pressure
In heart failure ( HF ), the heart cannot pump blood efficiently and is therefore unable to meet the body's demands of oxygen, and/or there is increased end‐diastolic pressure. Current treatments for HF with reduced ejection fraction ( HF r EF ) include angiotensin‐converting enzyme ( ACE ) inhibitors, angiotension receptor type 1 ( AT 1 ) antagonists, β‐adrenoceptor antagonists, aldosterone receptor antagonists, diuretics, digoxin and a combination drug with AT 1 receptor antagonist and neprilysin inhibitor. In HF , the risk of readmission for hospital and mortality is markedly higher with a heart rate (HR) above 70 bpm. Here, we review the evidence regarding the use of ivabradine for lowering HR in HF . Ivabradine is a blocker of an I funny current ( I (f)) channel and causes rate‐dependent inhibition of the pacemaker activity in the sinoatrial node. In clinical trials of HF r EF , treatment with ivabradine seems to improve clinical outcome, for example improved ejection fraction (EF) and less readmission for hospital, but the effect appears most pronounced in patients with HRs above 70 bpm, while the effect on cardiovascular death appears less consistent. The adverse effects of ivabradine include bradycardia, atrial fibrillation and visual disturbances, but ivabradine avoids the negative inotrope effects observed with β‐adrenoceptor antagonists. In conclusion, in patients with stable HF r EF with EF <35% and HR above 70 bpm, ivabradine improves the outcome and might be a first choice of therapy, if beta‐adrenoceptor antagonists are not tolerated. Further studies must show whether that can be extended to HF patients with preserved EF.