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Liao CT, Huang JL, Liang HW, Chung FP, Lee YH, Lin PL, Chiou WR, Lin WY, Hsu CY, Chang HY. The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients. ESC Heart Fail 2021; 8:4199-4210. [PMID: 34327853 PMCID: PMC8497193 DOI: 10.1002/ehf2.13536] [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] [Received: 03/23/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022] Open
Abstract
Aims Ivabradine has been used in patients who have chronic heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant sinus heart rate ≥70 bpm. This administration for acute HFrEF remains a concern. This study used a real‐world multicentre database to investigate the effects of ivabradine among patients with acute decompensated HFrEF before discharge. Methods and results This study retrospectively identified patients with acute decompensated HFrEF who were administered ivabradine at discharge from two multicentre HF databases. Propensity score matching was performed to adjust for confounders. Cardiovascular mortality, all‐cause mortality, and recurrent HF rehospitalization risks were then compared between those with and without ivabradine treatment. After 1:2 propensity score matching, 876 patients (age, 60.7 ± 14.6 years; female, 23.2%; left ventricular ejection fraction, 28.2% ± 7.8%; and heart rate at discharge, 84.3 ± 13.8 bpm) were included in the final analysis, including 292 and 584 patients with and without ivabradine treatment at discharge, respectively. No significant differences were observed in baseline characteristics between the two groups. At 1 year follow‐up, patients in the ivabradine group had significantly lower heart rates (77.6 ± 14.7 vs. 81.1 ± 16.3 bpm; P = 0.005) and lower HF severity symptoms (New York Heart Association Functional class, 2.1 ± 0.7 vs. 2.3 ± 0.9; P < 0.001) than those from the non‐ivabradine group. Ivabradine users had significantly lower risks of 1 year cardiovascular mortality (5.8 vs. 12.2 per 100‐person year; P = 0.003), all‐cause mortality (7.2 vs. 14.0 per 100‐person year; P = 0.003), and total HF rehospitalization (42.3 vs. 72.6 per 100‐person year; P < 0.001) than non‐ivabradine users. Following multivariate analysis, the predischarge prescription of ivabradine remained independently associated with lower 1 year all‐cause mortality (hazard ratio, 0.45; 95% confidence interval, 0.28–0.74; P = 0.002) and cardiovascular mortality (hazard ratio, 0.41; 95% confidence interval, 0.24–0.72; P = 0.002). Conclusions The current study findings suggest that ivabradine treatment is associated with reduced risks of cardiovascular mortality, all‐cause mortality, and HF rehospitalization within 1 year among patients with acute decompensated HFrEF in real‐world populations.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Wen Liang
- Division of Cardiology, Department of Internal Medicine, E-Da hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fa-Po Chung
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan.,Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Po-Lin Lin
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Wei-Ru Chiou
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan.,Division of Cardiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Wen-Yu Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yi Hsu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Taipei Heart Institute, Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yu Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Heart Center, Cheng Hsin General Hospital, No.45 Cheng-Hsin Street, 112 Beitou, Taipei, Taiwan
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Lan WR, Lin SI, Liao FC, Chang HY, Tsai CT, Wu YJ, Liu PY, Chen CH, Lee YH. Effect of Reducing Heart Rate on Outcomes in Patients With Reduced Ejection Fraction. Am J Cardiol 2021; 150:77-81. [PMID: 34006371 DOI: 10.1016/j.amjcard.2021.03.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Since 1953, sinus tachycardia has been defined as a heart rate (HR) in sinus rhythm of >100 beats per minute (bpm). However, this number has never been formally evaluated, and no established threshold values for special groups, such as those with heart failure (HF) accompanied by a reduced ejection fraction (HFrEF). Herein, we provided evidence that lowering the HR of patients with HFrEF to <70 bpm with medications such as ivabradine improves outcomes. Numerous large-scale trials and smaller clinical studies have shown that reducing the HR in patients with HFrEF improves cardiovascular and overall outcomes. Evidence suggests that a HR of <70 bpm is appropriate for patients with HFrEF. Examination of HF registries indicates that in a large proportion of these patients the HR exceeds 80 bpm, and no consideration is given to lowering the HR, due in large part to lack of physician awareness of the benefits of a lower HR. Evidence indicates that the first-line medication for lowering HR in patients with HFrEF is ivabradine. In conclusion, the improved prognosis following appropriate HR management in patients with HFrEF suggest that the cut-off value for sinus tachycardia in these patients should be redefined as 75 bpm. Maintaining a HR of <70 bpm in patients with HFrEF is associated with improved cardiovascular and overall outcomes.
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