Key result
Ivabradine yields mixed results in HFpEF, improving exercise capacity but sometimes worsening outcomes.
Why the study?
Elevated heart rate in HFpEF is associated with worse outcomes, but beta-blockers have shown worse outcomes possibly due to negative inotropy, leaving the role of the non-inotropic heart-rate-reducing drug ivabradine to be evaluated.
Does ivabradine improve outcomes in patients with heart failure with preserved ejection fraction?
Does ivabradine improve outcomes in patients with heart failure with preserved ejection fraction?
Current evidence for the use of ivabradine in HFpEF is heterogeneous and inconclusive, highlighting the need for a large randomized clinical trial.
Inconclusive evidence advises against routine ivabradine use in HFpEF; leaves open efficacy pending dedicated RCTs.
Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of patients with heart failure. HFpEF carries almost similar morbidity and mortality outcomes to heart failure with reduced ejection fraction (HFrEF). Despite many trials, no management has been shown to improve mortality outcomes in HFpEF. An elevated heart rate in patients with HFpEF has been associated with worse outcomes. Previous trials on the use of beta-blockers in reducing the heart rate in patients with HFpEF have shown worse outcomes, possibly due to the negative inotropic effects. The funny current inhibitor, ivabradine, results in a reduced heart rate without affecting inotropy. Two randomized controlled trials and one cross-over study have evaluated the use of ivabradine in HFpEF patients. The outcomes of the trials have been heterogeneous; ivabradine showed improved exercise tolerance, no change in primary endpoints was seen l, and there was a worsening in the outcomes. Our review underscores the requirement of a large randomized clinical trial in the appropriate patient population.
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Nadeem et al. (2020) conducted a review in Heart Failure with Preserved Ejection Fraction (HFpEF). Ivabradine vs. Placebo was evaluated. Ivabradine demonstrated heterogeneous effects in patients with heart failure with preserved ejection fraction, improving exercise capacity in one trial but showing no benefit or worsening outcomes in others.
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