From coronary artery disease to heart failure: potential benefits of ivabradine

In addition to the beneficial effects of heart rate reduction for the prevention of angina, a lower heart rate is also associated with a more favourable prognosis in patients with coronary artery disease (CAD). A high resting heart rate is a strong predictor for cardiovascular mortality and morbidity in patients with CAD. Patients with resting heart rate above 77 bpm are also prone to more re-hospitalizations for cardiovascular reasons, independently of major risk factors compared with patients with lower resting heart rates. These issues are clinically important because they support the relevance of testing the effect of lowering heart rate to reduce cardiovascular mortality and morbidity. The value of ivabradine for reduction in hard cardiovascular events in patients with ischaemic heart disease is presently being tested in the ongoing large-scale BEAUTIFUL (morBidity–mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction) study. Also, the prognostic value of heart rate in patients with heart failure and the lack of intrinsic negative inotropic effects of ivabradine have prompted its evaluation in addition to modern multifaceted therapy of heart failure in the Systolic Heart failure treatment with If inhibitor ivabradine Trial (SHIFT). These large-scale clinical trials will help to determine whether the spectrum of patients benefiting from a pure heart rate-reducing agent, such as ivabradine, goes beyond those with angina and whether the clinical benefits are much greater than prevention of angina and extend to reduction in cardiovascular mortality and morbidity.