Key result
Ivabradine combined with a beta-blocker did not significantly reduce the combined endpoint of cardiovascular death and heart failure readmission compared to beta-blocker alone (RR 0.93; 95% CI 0.79-1.09; P=0.354).
Why the study?
The comparative outcomes of ivabradine combined with beta-blocker versus beta-blocker alone in HFrEF were not well established.
Does ivabradine combined with beta-blocker reduce the combined end point of cardiac death and hospitalization for heart failure in patients with HFrEF compared to beta-blocker alone?
Meta-Analysis (n=17,671)
Does ivabradine combined with beta-blocker reduce the combined end point of cardiac death and hospitalization for heart failure in patients with HFrEF compared to beta-blocker alone?
Relative Risk: 0.93 (95% CI 0.79–1.09)
p-value: p=0.354
In patients with HFrEF, adding ivabradine to beta-blockers significantly reduces heart rate but does not significantly improve the composite of cardiovascular death or heart failure hospitalization compared to beta-blockers alone.
Does not support adding ivabradine to beta-blockers in HFrEF; reinforces beta-blocker monotherapy for CV outcomes.
AIMTo perform a systematic-review and meta-analysis to compare outcomes of ivabradine combined with betablocker to beta-blocker alone in heart failure with reduced ejection fraction (HFrEF). METHODSWe searched PubMed, Cochrane, EMBASE, CINAHL and Web of Science for trials comparing ivabradine + betablocker to beta-blocker alone in HFrEF.We performed a systematic-review and meta-analysis of published literature.Primary end-point was combined end point of cardiac death and hospitalization for heart failure. RESULTSSix studies with 17671 patients were included.Mean follow-up was 8.7 ± 7.9 mo.Combined end-point of heart failure readmission and cardiovascular death was better in ivabradine + beta-blocker group compared to beta-blocker alone (RR: 0.93, 95%CI: 0.79-1.09,P = 0.354).Mean difference (MD) in heart rate was higher in the ivabradine + beta-blocker group (MD: 6.14, 95%CI: 3.80-8.48,P < 0.001).There was no difference in all cause mortality (RR: 0.98, 95%CI: 0.89-1.07,P = 0.609), cardiovascular mortality (RR: 0.99, 95%CI: 0.86-1.15,P = 0.908) or heart failure hospitalization (RR: 0.87, 95%CI: 0.68-1.11,P = 0.271). CONCLUSIONFrom the available clinical trials, ivabradine + betablocker resulted in a significantly greater reduction in HR
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Narayanan et al. (2017) conducted a meta-analysis in Heart failure with reduced ejection fraction (HFrEF) (n=17,671). Ivabradine + beta-blocker vs. Beta-blocker alone was evaluated on Combined end point of cardiac death and hospitalization for heart failure (RR 0.93, 95% CI 0.79-1.09, p=0.354). Ivabradine combined with a beta-blocker did not significantly reduce the combined endpoint of cardiovascular death and heart failure readmission compared to beta-blocker alone (RR 0.93; 95% CI 0.79-1.09; P=0.354).
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