Healthcare

Patients with chronic systolic heart failure (CSHF) may reduce the risk of cardiovascular death or heart-failure hospitalization by adding Ivabradine (a selective inhibitor of a sodium-potassium).

Presented in August 29, at the European Society of Cardiology (ESC) Congress 2010, in August 29, according to the author, Dr Michel Komajda from Groupe Hospitalier Pitié-Salpêtrière, Paris, France, compared with placebo control group, CSHF patients who added ivabradine to the medications they were already taking, showed a significant 18% drop in the composite rate of heart-failure hospitalization or cardiovascular death.

This finding based on recent Systolic Heart Failure Treatment with the I f Inhibitor Ivabradine Trial (SHIFT) results, whereas also simultaneously published in the Lancet by first author Dr Karl Swedberg from the University of Gothenburg, Sweden.

According to Dr Inder Anand from the University of Minnesota, Minneapolis, as assigned discussant was upbeat about the trial’s implications and ivabradine’s potential as an addition to the array of medications that can make a significant difference in heart failure.

He said, “SHIFT confirms the importance of heart rate in the pathophysiology of heart failure and support the concept that reduction of heart rate contributes significantly to beneficial outcomes in patients with heart failure. It appears therefore likely that heart rate is not only a risk factor but may well be a mediator of the progression of heart failure.”

He explained, ivabradine is likely to improve the outcomes in patients with systolic heart failure who are in sinus rhythm, with heart rates over 70 bpm, receiving the usual clinical care, who are unable to tolerate higher doses of beta blockers.

However, there is questioned about relevancy to contemporary practice cause it has expressed cautions about the trial and its message.

According to editorial accompanying, it’s premature to list ivabradine among proven therapies for heart failure due to questions how far the study’s results can be generalized. They point out shortfalls in the background medical therapy of SHIFT participants, at least according to contemporary standards.

Overall, despite this drug had 10% rate of bradycardia which prompted withdrawal from the study by 1% of patients receiving the drug, the authors describe ivabradine as being “well tolerated”.

According to the author, that low rate is “reassuring”. Bradycardia would be an obvious potential concern when adding a heart-rate-lowering agent to other drugs, notably beta blockers, that also lower heart rate.

He noted that only one patients in the trial needed implantation of a pacemaker, “which tells you about the safety of this drug in terms of bradycardia. One of the message of SHIFT is that there is very good tolerance of ivabradine on top of beta blockers.”