Addition of Ivabradine to β-Blocker Improves Exercise Capacity in Systolic Heart Failure Patients in a Prospective, Open-Label Study

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• 作者：A. E. Bagriy ; E. V. Schukina ; O. V. Samoilova ; O. A. Pricolota…
• 关键词：Heart rate ; Heart failure ; Ivabradine ; Carvedilol ; β ; blockers
• 刊名：Advances in Therapy
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：32
• 期：2
• 页码：108-119
• 全文大小：781 KB
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• 刊物主题：Internal Medicine; Oncology; Cardiology; Rheumatology; Endocrinology; Pharmacology/Toxicology;
• 出版者：Springer Healthcare
• ISSN：1865-8652

文摘

Introduction Difficulties initiating and uptitrating β-blockers due to tolerability can complicate management of heart failure. Among other actions, β-blockers reduce heart rate, which is an important cardiovascular risk factor in heart failure. A new therapeutic strategy is ivabradine, which reduces resting heart rate and is associated with improved outcomes. Methods A 5-month, prospective, open-label, nonrandomized single-center study was performed in 69 patients. All patients had chronic heart failure with left ventricular systolic dysfunction in sinus rhythm, each were initiated on 3.125?mg twice daily (bid) carvedilol alone (n?=?36) or 3.125?mg bid carvedilol/5?mg bid ivabradine (n?=?33), on top of background therapy including angiotensin-converting enzyme inhibitor (88%), diuretics (86%), antiplatelet agents (91%), and statins (90%). Dosages were uptitrated every 2?weeks to 25?mg bid carvedilol in both groups and 7.5?mg bid ivabradine maximum in the carvedilol/ivabradine group. Uptitration of carvedilol lasted 1.9?±?0.4?months with carvedilol/ivabradine and 2.8?±?0.6?months with carvedilol alone (P? Results The patients receiving ivabradine had lower resting heart rate at 5?months (61.6?±?3.1 versus 70.2?±?4.4?bpm, P?P? Conclusion Adding ivabradine to carvedilol in patients with chronic heart failure improves the uptitration of β-blocker. The results merit further verification in a prospective double-blind study.