Ivabradine for chronic heart failure?

In the UK, over 900,000 patients have chronic heart failure and more than 60,000 develop the condition each year.(1,2) Patients with heart failure suffer significantly reduced quality of life and have a poor prognosis. It is estimated that heart failure accounts for around 2% of the total NHS budget, 70% of which is related to the costs of hospitalisation.(3) The main pharmacological interventions that are currently used to manage heart failure include angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor antagonists (AIIRAs), beta-blockers and aldosterone antagonsists. Ivabradine (Procoralan - Servier) is a "pure heart rate lowering agent, acting by selective and specific inhibition of the cardiac pacemaker I(f) current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate".(4) It has been licensed in the UK since 2006 for the symptomatic treatment of chronic stable angina in patients with normal sinus rhythm.(5) Earlier this year ivabradine was granted marketing authorisation for the treatment of chronic heart failure. Here we review the role of ivabradine for this new indication.