Key result
Ivabradine plus metoprolol is linked to a ~90% reduction in weekly angina attacks.
Why the study?
Does the combination of ivabradine and metoprolol improve angina symptoms and quality of life in patients with stable angina and CAD?
Observational (n=636)
Does the combination of ivabradine and metoprolol improve angina symptoms and quality of life in patients with stable angina and CAD?
Absolute Event Rate: 0.2% vs 2%
p-value: p=<0.001
The combination of ivabradine and metoprolol significantly reduces angina symptoms and improves quality of life in patients with stable angina.
Ivabradine added to metoprolol was associated with fewer angina symptoms and better QoL; hypothesis-generating and should not yet change practice in stable CAD.
Medical treatment is the main clinical strategy for controlling patients with chronic stable angina and improving their quality of life (QoL). Ivabradine treatment on top of metoprolol decreases angina symptoms and improves QoL in patients with stable angina and coronary artery disease (CAD). This is a post hoc analysis (636 CAD patients given ivabradine/metoprolol free combination) of a prospective, noninterventional study that included 2403 patients with CAD and stable angina. Data were recorded at baseline at 1 and 4 months after inclusion. Patient QoL was assessed using the EQ-5D questionnaire. From baseline to study completion; ivabradine administration on top of metoprolol decreased heart rate (HR) from 80.8 ± 9.6 to 64.2 ± 6.2 bpm (P < 0.001). Mean number of angina attacks decreased from 2.0 ± 2.0/wk to 0.2 ± 0.6/wk (P < 0.001), whereas nitroglycerin consumption decreased from 1.4 ± 1.9 times/wk to 0.1 ± 0.4 times/wk (P < 0.001). The percentage of patients in Canadian Cardiovascular Society angina class III to IV decreased from 15.4% to 1.9% (P < 0.001). The improvement of symptoms and angina class led to a significant 14.7-point increase in EQ-5D questionnaire score (P < 0.001). Patients with increased HR showed greater improvement (P = 0.001). Adherence to treatment during the entire trial was high (98%). Ivabradine combined with metoprolol significantly decreased angina symptoms and use of nitroglycerin in patients with stable angina and CAD, leading to improved QoL. The benefits observed with this combination explain the high rate of adherence to treatment.
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Zarifis et al. (2016) conducted an observational in Stable angina and coronary artery disease (n=636). Ivabradine/metoprolol combination vs. Baseline was evaluated on Mean number of angina attacks per week (p=<0.001). Ivabradine combined with metoprolol significantly decreased the mean number of angina attacks from 2.0 to 0.2 per week (P<0.001) and improved quality of life over 4 months.
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