1
|
Khan ZM, Briere JB, Olewinska E, Khrouf F, Nikodem M. Ivabradine in patients with heart failure: a systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2262073. [PMID: 37808119 PMCID: PMC10552613 DOI: 10.1080/20016689.2023.2262073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
Background: Heart failure is a chronic disease linked with significant morbidity and mortality, and uncontrolled resting heart rate is a risk factor for adverse outcomes. This systematic literature review aimed to assess the efficacy, safety, and patient-reported outcomes (PROs) of ivabradine in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in randomized controlled trials (RCTs) and observational studies. Methods: We searched electronic databases from their inception to July 2021 to include studies that reported on efficacy, safety, or PROs of ivabradine in patients with HFrEF. Results: Of 1947 records screened, 51 RCTs and 6 observational studies were identified. Ivabradine on top of background therapy demonstrated a significant reduction in composite outcomes including hospitalization for HF or cardiovascular death. In addition, observational studies suggested that ivabradine was associated with a significant reduction in mortality. Across all studies, ivabradine use on top of background therapy was associated with greater reductions in heart rate, improved EF, and improved health-related quality of life (QoL) and comparable risk of total adverse events compared to those treated with background therapy alone. Conclusions: Ivabradine on top of background therapy is beneficial for heart rate, hospitalization risk for HF, mortality, EF, and patients' QoL. Moreover, these benefits were achieved with no significant increase in the overall risk of total adverse events.
Collapse
Affiliation(s)
| | | | | | - Fatma Khrouf
- Health Economics and Outcome Research, Putnam PHMR, Tunis, Tunisia
| | - Mateusz Nikodem
- Health Economics and Outcome Research, Putnam PHMR, Cracow, Poland
| |
Collapse
|
2
|
Ali U, Ahmad T, Khan J, Khan MI, Khan H, Javed B. Comparison of Efficacy of Ivabradine With Traditional Therapy in Patients With Left Ventricular Dysfunction. Cureus 2021; 13:e19192. [PMID: 34873532 PMCID: PMC8635682 DOI: 10.7759/cureus.19192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Heart failure patients usually present with disease exacerbation that overburdens the hospitals and also increases the risk of mortality with increased heart rate being the main issue. Consideration is being given to drugs for sole heart rate control in addition to conventional therapy. Objective: To compare the outcomes of ivabradine to traditional treatment in patients with left ventricular systolic dysfunction. Methodology: This randomized controlled trial was conducted in the Department of Cardiology, Khyber Teaching Hospital, Peshawar from November 1, 2020, to May 31, 2021. Patients aged 30-65 years of age and of either gender with heart failure were enrolled in the study. Patients were screened for New York Heart Association (NYHA) class and were enrolled into one of the two groups. In group 1, patients were started on traditional treatment, while group 2 patients were given ivabradine as an add-on therapy. Follow-up was made at the end of the second month for evaluation of the outcomes. Results: Each group had 119 patients, with a mean age of 58.05±4.98 years. Group 1, consisted of 61.3% of the patients in NYHA 3, while 38.65% were in NYHA 4. In group 2, NYHA 3 and NYHA 4 patients were 59.6% and 40.3%, respectively. Upon follow-up, there were greater improvements in group 2 as compared to group 1 based on NYHA classifications, with NYHA 2 [47.05% (group 2) vs. 13.44% (group 1)], NYHA 3 [42.85% (group 2) vs. 61.34% (group 1)] and NYHA 4 [10.08% (group 2) vs. 25.21% (group 1)], p < 0.05. Conclusions: Obtaining a more optimal heart rate with ivabradine in patients with congestive heart failure is reflected in an improvement in NYHA classification.
Collapse
Affiliation(s)
- Umair Ali
- Cardiology, Khyber Teaching Hospital Peshawar Pakistan, Peshawar, PAK
| | - Tanveer Ahmad
- Cardiology Department, Qazi Hussain Ahmed Medical Complex, Nowshera, PAK
| | - Jehanzeb Khan
- Cardiology, Lady Reading Hospital, Peshawar, PAK.,Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, London, GBR
| | - Muhammad Ijaz Khan
- Medicine Unit, Khyber Teaching Hospital, Peshawar, PAK.,Internal Medicine, University Hospital, Tralee, IRL
| | | | - Bilal Javed
- Medicine, Quaideazam Medical College, Bahawalpur, PAK
| |
Collapse
|
3
|
Vaduganathan M, Claggett BL, Greene SJ, Aggarwal R, Bhatt AS, McMurray JJV, Fonarow GC, Solomon SD. Potential Implications of Expanded US Food and Drug Administration Labeling for Sacubitril/Valsartan in the US. JAMA Cardiol 2021; 6:1415-1423. [PMID: 34524394 DOI: 10.1001/jamacardio.2021.3651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance The US Food and Drug Administration (FDA) expanded labeling for sacubitril/valsartan for use in individuals with chronic heart failure (HF) with left ventricular ejection fraction (LVEF) lower than normal. The population-level implications of implementation of sacubitril/valsartan at higher LVEF ranges is unknown. While the Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction (PARAGON-HF) trial did not meet its primary end point, the trial may provide useful information in projecting expected clinical events among treated individuals. Objective To quantify newly eligible treatment candidates for sacubitril/valsartan under the expanded FDA labeling and to apply treatment effects and the number needed to treat (NNT) to prevent 1 worsening HF event derived from subgroups of the PARAGON-HF trial who fall under the revised FDA label. Design, Setting, and Participants Newly eligible treatment candidates were estimated by mapping the LVEF distribution from 559 520 adult patients hospitalized between 2014 and 2019 in the Get With The Guidelines-Heart Failure registry to adults self-identifying with HF in the National Health and Nutrition Examination Survey (2015 to 2018). The NNT with 3 years of treatment for 3 end points of interest (total HF hospitalizations, total HF hospitalizations and cardiovascular death, and total HF hospitalizations and urgent HF visits and cardiovascular death) were estimated from the PARAGON-HF trial. Data were analyzed from February to June 2021. Main Outcomes and Measures Number of worsening HF events prevented or postponed if eligible patients were treated with sacubitril/valsartan for 3 years. Results Of an estimated 4 682 098 adults, the mean (SE) age was 66.3 (0.8) years, 1 995 037 (42.6%) were women, and 748 045 (16.0%) were Black. The potential number of adults projected to be newly eligible varied by the definition of FDA labeling of lower than normal LVEF from 643 161 (95% CI, 534 433-751 888; LVEF of 41% to 50%) to 1 838 756 (95% CI, 1 527 911-2 149 601; LVEF of 41% to 60%). In the PARAGON-HF trial, the NNT to prevent a worsening HF event (range, 7 to 12 patients) was consistent irrespective of specific LVEF range selected. Comprehensive implementation of sacubitril/valsartan among newly eligible patients was empirically estimated to prevent up to 69 268 (95% CI, 57 558-80 978) worsening HF events (LVEF of 41% to 50%) to 182 592 (95% CI, 151 725-213 460) worsening HF events (LVEF of 41% to 60%). Conclusions and Relevance The expanded FDA labeling is positioned to substantially increase the potential HF population eligible for sacubitril/valsartan by up to 1.8 million individuals and has the potential to prevent or postpone as many as 180 000 worsening HF events, depending on the definition of normal LVEF.
Collapse
Affiliation(s)
- Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Rahul Aggarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ankeet S Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles.,Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Jhund PS, Ponikowski P, Docherty KF, Gasparyan SB, Böhm M, Chiang CE, Desai AS, Howlett J, Kitakaze M, Petrie MC, Verma S, Bengtsson O, Langkilde AM, Sjöstrand M, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Sabatine MS, Solomon SD, McMurray JJV. Dapagliflozin and Recurrent Heart Failure Hospitalizations in Heart Failure With Reduced Ejection Fraction: An Analysis of DAPA-HF. Circulation 2021; 143:1962-1972. [PMID: 33832352 PMCID: PMC8126492 DOI: 10.1161/circulationaha.121.053659] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with heart failure (HF) and reduced ejection fraction will experience multiple hospitalizations for heart failure during the course of their disease. We assessed the efficacy of dapagliflozin on reducing the rate of total (ie, first and repeat) hospitalizations for heart failure in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure).
Collapse
Affiliation(s)
- Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Samvel B Gasparyan
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (S.B.G., O.B., A.-M.L., M.S.)
| | - Michael Böhm
- The Department of Medicine, Saarland University Hospital, Homburg-Saar, Germany (M.B.)
| | - Chern-En Chiang
- Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan (C.-E.C.)
| | - Akshay S Desai
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., S.D.S.)
| | - Jonathon Howlett
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Alberta, Canada (J.H.)
| | - Masafumi Kitakaze
- Cardiovascular Division of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (M.K.)
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Canada (S.V.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (S.B.G., O.B., A.-M.L., M.S.)
| | - Anna-Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (S.B.G., O.B., A.-M.L., M.S.)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (S.B.G., O.B., A.-M.L., M.S.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.S.S.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., S.D.S.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., M.C.P., J.J.V.M.)
| |
Collapse
|
5
|
Vasudevan A, Choi JW, Feghali GA, Kluger AY, Lander SR, Tecson KM, Sathyamoorthy M, Schussler JM, Stoler RC, Vallabhan RC, Velasco CE, Yoon A, McCullough PA. First and recurrent events after percutaneous coronary intervention: implications for survival analyses. SCAND CARDIOVASC J 2019; 53:299-304. [PMID: 31315473 DOI: 10.1080/14017431.2019.1645349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Using composite endpoints and/or only first events in clinical research result in information loss and alternative statistical methods which incorporate recurrent event data exist. We compared information-loss under traditional analyses to alternative models. Design. We conducted a retrospective analysis of patients who underwent percutaneous coronary intervention (Jan2010-Dec2014) and constructed Cox models for a composite endpoint (readmission/death), a shared frailty model for recurrent events, and a joint frailty (JF) model to simultaneously account for recurrent and terminal events and evaluated the impact of heart failure (HF) on the outcome. Results. Among 4901 patients, 2047(41.8%) experienced a readmission or death within 1 year. Of those with recurrent events, 60% had ≥1 readmission and 6% had >4; a total of 121(2.5%) patients died during follow-up. The presence of HF conferred an adjusted Hazard ratio (HR) of 1.32 (95% CI: 1.18-1.47, p < .001) for the risk of composite endpoint (Cox model), 1.44 (95% CI: 1.36-1.52, p < .001) in the frailty model, and 1.34 (95% CI:1.22-1.46, p < .001) in the JF model. However, HF was not associated with death (HR 0.87, 95% CI: 0.52-1.48, p = .61) in the JF model. Conclusions. Using a composite endpoint and/or only the first event yields substantial loss of information, as many individuals endure >1 event. JF models reduce bias by simultaneously providing event-specific HRs for recurrent and terminal events.
Collapse
Affiliation(s)
- Anupama Vasudevan
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - James W Choi
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Georges A Feghali
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Aaron Y Kluger
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Stuart R Lander
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Kristen M Tecson
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Mohanakrishnan Sathyamoorthy
- Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Jeffrey M Schussler
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Robert C Stoler
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Ravi C Vallabhan
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Carlos E Velasco
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Anthony Yoon
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Peter A McCullough
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| |
Collapse
|
6
|
Ide T, Ohtani K, Higo T, Tanaka M, Kawasaki Y, Tsutsui H. Ivabradine for the Treatment of Cardiovascular Diseases. Circ J 2018; 83:252-260. [PMID: 30606942 DOI: 10.1253/circj.cj-18-1184] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Higher heart rate (HR) is independently related to worse outcomes in various cardiac diseases, including hypertension, coronary artery disease, and heart failure (HF). HR is determined by the pacemaker activity of cells within the sinoatrial node. The hyperpolarization-activated cyclic nucleotide-gated (HCN) 4 channel, one of 4 HCN isoforms, generates the If current and plays an important role in the regulation of pacemaker activity in the sinoatrial node. Ivabradine is a novel and only available HCN inhibitor, which can reduce HR and has been approved for stable angina and chronic HF in many countries other than Japan. In this review, we summarize the current knowledge of the HCN4 channel and ivabradine, including the function of HCN4 in cardiac pacemaking, the mechanism of action of If inhibition by ivabradine, and the pharmacological and clinical effects of ivabradine in cardiac diseases as HF, coronary artery disease, and atrial fibrillation.
Collapse
Affiliation(s)
- Tomomi Ide
- Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kisho Ohtani
- Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
7
|
Rocha BML, Menezes Falcão L. Acute decompensated heart failure (ADHF): A comprehensive contemporary review on preventing early readmissions and postdischarge death. Int J Cardiol 2016; 223:1035-1044. [PMID: 27592046 DOI: 10.1016/j.ijcard.2016.07.259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/16/2016] [Accepted: 07/30/2016] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) is an increasingly prevalent syndrome and a leading cause of both first hospitalization and readmissions. Strikingly, up to 25% of the patients are readmitted within 30 to 60-days, accounting for HF as the primary cause for readmission in the adult population. Given its poor prognosis, one could describe it as a "malignant condition". Acute decompensation is intrinsically related to increased right heart tele-diastolic pressures and often related to congestive symptoms. In-hospital strategies to adequately compensate and timely discharge patients are limited. Conversely, the fragile early postdischarge phase is a vulnerable period when one could potentially intervene cost-effectively to improve survival and to reduce morbidity. Promising transitional hospital-to-home programs may have a broader role in the near future, namely for selected higher risk patients. However, identifying patients at risk for hospital readmission has been challenging. Novel approaches, such as ferric carboxymaltose and valsartan/sacubitril, and reemerging drugs, particularly digoxin, may reduce hospitalizations. Despite this, optimizing the use of "older" therapies is still warranted. Right heart pressures monitoring may provide novel insights into promptly outpatient management. Unfortunately, randomized trials in the specific ADHF population are scarce. A novel paradigmatic approach is needed in order to suitably improve the currently poor prognosis of ADHF. Both improving survival and reducing hospitalizations are, therefore, primordial therapy goals. Lastly, no single drug has consistently proved to improve survival in HF with preserved ejection fraction (HFpEF); yet, some approaches may efficiently reduce hospitalizations. Awareness on HFpEF management beyond the failing heart is imperative.
Collapse
Affiliation(s)
- Bruno M L Rocha
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| | - Luiz Menezes Falcão
- Department of Internal Medicine, Hospital Santa Maria, Lisbon, Portugal, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
| |
Collapse
|
8
|
Vaduganathan M, Patel RB, Greene SJ, Gheorghiade M. Targeting the vulnerable phase of heart failure: initiate novel therapies in stable patients prior to hospitalization. Eur J Heart Fail 2016; 18:1190-2. [DOI: 10.1002/ejhf.598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/22/2023] Open
Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School; Boston MA USA
| | - Ravi B. Patel
- Division of Cardiology; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Stephen J. Greene
- Division of Cardiology; Duke University Medical Center; Durham NC USA
| | - Mihai Gheorghiade
- Division of Cardiology; Northwestern University Feinberg School of Medicine; Chicago IL USA
| |
Collapse
|
9
|
Abstract
We reviewed clinical evidence for the use of ivabradine in systolic heart failure (HF), in which it appears to improve symptoms, improve quality of life, prevent hospitalization, and prolong survival, thereby addressing unmet needs in the management of HF. Ivabradine provides symptomatic benefits in HF on top of standard therapies, in terms of functional parameters and exercise capacity, and there is some evidence that this leads to improvements in quality of life in symptomatic HF patients, who may have dyspnea, altered exercise capacity, and fatigue. The SHIFT trial demonstrated that ivabradine has significant beneficial effects on major outcomes in HF. Ivabradine had a significant effect on pump failure death, which was reduced by 26 % (p = 0.014), with no effect on sudden cardiac death. This is an important result since pump failure death is currently the main cause of death in HF, and also because the reductions in mortality obtained with beta-blockers and spironolactone in the last 20 years appear to be mainly due to reduction in sudden death rather than reduction in pump failure death. Ivabradine also has a beneficial effect on hospital admissions (-26 %, p < 0.0001), which is clinically relevant since a quarter of HF patients can expect to be readmitted to hospital for HF within 1 month of discharge. Ivabradine-treated patients are also at significantly lower risk of experiencing a second or third hospitalization for worsening HF. Ivabradine clearly has a key role to play in the management of HF by covering the main therapeutic objectives of symptoms, quality of life, and outcomes.
Collapse
Affiliation(s)
- Antonio Carlos Pereira-Barretto
- Prevention and Rehabilitation Service, Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 44, São Paulo, SP, CEP 05403-900, Brazil.
| |
Collapse
|
10
|
Borer JS, Tavazzi L. Update on ivabradine for heart failure. Trends Cardiovasc Med 2016; 26:444-9. [PMID: 26934996 DOI: 10.1016/j.tcm.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Abstract
Despite dramatic advances in therapy for heart failure (HF) during the past 3 decades, hospitalization and mortality rates remain relatively high. In recent decades, it has become apparent that HF is divisible into two equally lethal but pathophysiologically different sub-classes, the first comprising patients with LV systolic dysfunction [heart failure with reduced ejection fraction (HFrEF)] and the other, approximately equal in size, involving patients with "preserved" systolic function [heart failure with preserved ejection fraction (HFpEF)]. Evidence-based event reducing therapy currently is available only for HFrEF. With the completion of seminal trials of beta blockers, now part of standard therapy for HFrEF, it was apparent that heart rate slowing is an underlying basis of clinical effectiveness of HFrEF therapy. With the discovery of the "f current" that modulates the slope of spontaneous diastolic depolarization of the sino-atrial node, a non-beta blockade approach to heart rate slowing became available. Ivabradine, the first FDA-approved f-current blocker for HFrEF, markedly reduces hospitalizations for worsening heart failure, while also progressively reducing mortality as pre-therapy heart rate increases, and also promotes beneficial left ventricular remodeling, improves health-related quality of life and is effective despite a wide range of comorbidities. The drug is well tolerated and adverse effects are relatively few. Ivabradine represents an important addition to the armamentarium for mitigation of HFrEF.
Collapse
Affiliation(s)
- Jeffrey S Borer
- The Howard Gilman Institute for Heart Valve Disease, and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, Brooklyn and New York, NY.
| | - Luigi Tavazzi
- GVM Care&Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
| |
Collapse
|
11
|
Abstract
The prevalence of heart failure is expected to increase almost 50% in the next 15 years because of aging of the general population, an increased frequency of comorbidities, and an improved survival following cardiac events. Conventional treatments for heart failure have remained largely static over the past 20 years, illustrating the pressing need for the discovery of novel therapeutic agents for this patient population. Given the heterogeneous nature of heart failure, it is important to specifically define the cellular mechanisms in the heart that drive the patient's symptoms, particularly when considering new treatment strategies. This report highlights the latest research efforts, as well as the possible pitfalls, in cardiac disease translational research and discusses future questions and considerations needed to advance the development of new heart failure therapies. In particular, we discuss cardiac remodeling and the translation of animal work to humans and how advancements in our understanding of these concepts relative to disease are central to new discoveries that can improve cardiovascular health.
Collapse
Affiliation(s)
- Michael S Kapiloff
- Cardiac Signal Transduction and Cellular Biology Laboratory, Interdisciplinary Stem Cell Institute, Departments of Pediatrics and Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Craig A Emter
- Department of Biomedical Sciences, University of Missouri-Columbia, Columbia, MO, USA
| |
Collapse
|