Key result
Achieving an optimal heart rate within 10 bpm of an individualized ideal heart rate during ivabradine therapy was associated with a significantly lower incidence of cardiovascular death and heart failure readmissions (HR 0.10) in patients with HFrEF.
Why the study?
The prognostic impact of mitral inflow wave overlap during ivabradine therapy in patients with HFrEF remains unknown.
Does achieving an individualized ideal heart rate with ivabradine improve a composite of cardiovascular death and heart failure readmissions in patients with HFrEF?
Observational (n=16)
No
Does achieving an individualized ideal heart rate with ivabradine improve a composite of cardiovascular death and heart failure readmissions in patients with HFrEF?
Hazard Ratio: 0.1 (95% CI 0.01–0.91)
Absolute Event Rate: 40% vs 100%
p-value: p=0.013
Achieving an individualized ideal heart rate based on mitral inflow wave overlap during ivabradine therapy may significantly reduce cardiovascular death and heart failure readmissions in HFrEF patients.
Mitral inflow overlap on ivabradine may associate with HFrEF prognosis; leaves open need for prospective validation before clinical use.
The prognostic impact of mitral inflow wave overlap during ivabradine therapy in patients with heart failure with reduced ejection fraction (HFrEF) remains to be unknown. Thus, in this study, we have retrospectively examined consecutive inpatients with HFrEF admitted with decompensated heart failure who continued ivabradine following the index discharge. Ideal heart rate (HR), at which echocardiographic mitral inflow wave overlap is theoretically 0, was retrospectively calculated as follows: 96 - 0.13 × (deceleration time [msec]). HR difference was then calculated as follows: actual HR - ideal HR. The association between the HR difference at index discharge and a composite outcome of cardiovascular death and heart failure readmissions was investigated. In total, 16 patients (68 [47, 75] years old, 11 men, median left ventricular ejection fraction 28% [22%, 35%]) were included in this study for analysis. Baseline actual HR was determined to be 88 (81, 93) bpm, whereas the ideal HR was calculated as 75 (73, 76) bpm. Following the initiation of ivabradine, actual HR at index discharge was 75 (64, 84) bpm. Patients with optimal HR (actual HR - ideal HR < ± 10 bpm; n = 9) were found to have experienced a lower incidence of the composite endpoint (40% versus 100%, P = 0.013) compared with those with sub-optimal HR (n = 7) with a hazard ratio of 0.10 (95% confidence interval 0.01-0.91) adjusted for actual HR at index discharge. In conclusion, HR modulation therapy using ivabradine may improve outcomes in patients with HFrEF if individualized ideal HR was achieved.
No takes yet. Share an insight, caveat, or question.
Imamura et al. (2022) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=16). Optimal heart rate (actual HR within 10 bpm of ideal HR) vs. Sub-optimal heart rate (actual HR difference ≥ 10 bpm from ideal HR) was evaluated on Composite of cardiovascular death and heart failure readmissions (HR 0.10, 95% CI 0.01-0.91, p=0.013). Achieving an optimal heart rate within 10 bpm of an individualized ideal heart rate during ivabradine therapy was associated with a significantly lower incidence of cardiovascular death and heart failure readmissions (HR 0.10) in patients with HFrEF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: