Key result
Ivabradine improves LVEF ~6% vs placebo in HFrEF and lowers heart rate in HFrEF and HFpEF.
Why the study?
Ivabradine reduces cardiovascular death in HFrEF but failed to improve cardiovascular outcomes in HFpEF despite lowering heart rate, prompting a direct comparison of its effects between the two conditions.
Does ivabradine improve heart rate, mortality, and left ventricular function differently in heart failure patients with reduced versus preserved ejection fraction?
Meta-Analysis
Does ivabradine improve heart rate, mortality, and left ventricular function differently in heart failure patients with reduced versus preserved ejection fraction?
Effect estimate: 5.936 (95% CI 4.199-7.672)
p-value: p=<0.001
Ivabradine significantly improves left ventricular performance and tends to have a stronger bradycardic effect in HFrEF compared to HFpEF, potentially explaining its disparate clinical outcomes in these populations.
Supports ivabradine for LVEF gains in HFrEF; extends meta-analytic evidence of stronger effects versus HFpEF.
In clinical trials of heart failure reduced ejection fraction (HFrEF), ivabradine seemed to be an effective heart rate lowering agent associated with lower risk of cardiovascular death. In contrast, ivabradine failed to improve cardiovascular outcomes in heart failure preserved ejection fraction (HFpEF) despite the significant effect on heart rate. This meta-analysis is the first to compare the effects of ivabradine on heart rate and mortality parameters in HFpEF versus HFrEF. We screened three databases: PubMed, Embase, and Cochrane Library. The outcomes of these studies were mortality, reduction in heart rate, and left ventricular function improvement. We compared the efficacy of ivabradine treatment in HFpEF versus HFrEF. Heart rate analysis of pooled data showed decrease in both HFrEF (–17.646 beats/min) and HFpEF (–11.434 beats/min), and a tendency to have stronger bradycardic effect in HFrEF (p = 0.094) in randomized clinical trials. Left ventricular ejection fraction analysis revealed significant improvement in HFrEF (5.936, 95% CI: [4.199–7.672], p < 0.001) when compared with placebo (p < 0.001). We found that ivabradine significantly improves left ventricular performance in HFrEF, at the same time it exerts a tendency to have improved bradycardic effect in HFrEF. These disparate effects of ivabradine and the higher prevalence of non-cardiac comorbidities in HFpEF may explain the observed beneficial effects in HFrEF and the unchanged outcomes in HFpEF patients after ivabradine treatment.
No takes yet. Share an insight, caveat, or question.
Tóth et al. (2021) conducted a meta-analysis in Heart failure with reduced (HFrEF) versus preserved (HFpEF) ejection fraction. Ivabradine vs. Placebo was evaluated on Left ventricular ejection fraction improvement (5.936, 95% CI 4.199-7.672, p=<0.001). Ivabradine significantly improved left ventricular ejection fraction in HFrEF compared with placebo (5.936; 95% CI 4.199-7.672; p<0.001) and reduced heart rate in both HFrEF and HFpEF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: