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Ivabradine, a specific If current inhibitor, improves prognosis in patients with chronic heart failure (CHF) and is recommended by ESC Guidelines for symptomatic CHF patients with elevated heart rate (HR) on evidence-based or maximum tolerated doses of β-blocker (BB) and RAAS antagonists. However, many patients tolerate BB poorly and few reach target dose.
To compare the uptitration of carvedilol alone or with ivabradine in CHF patients.
41 patients (27 men) in sinus rhythm with previous MI, CHF (NYHA class II-III), and HR ≥70 bpm. Participants had not taken BB for ≥2 months and were ivabradine-naïve. Patients were divided into 2 groups: 21 patients on carvedilol, and 20 patients on carvedilol and ivabradine. Carvedilol 3.125 mg bid was initiated on top of standard therapy, and doubled every 2 weeks until 25 mg bid or maximum tolerated dose was reached. Ivabradine 5 mg bid was prescribed 1-2 days after carvedilol initiation, and uptitrated to 7.5 mg bid 1 month later if HR ≥70 bpm. The final visit was at 3 months.
Mean age was 61.7±10.4 years, baseline HR was 83.8±11.6 bpm, and baseline systolic BP was 133.3±13.8 mm Hg. Sex, age, and severity of CHF were similar in both groups. The most common reasons for not reaching BB target dose were hypotension, dizziness, and worsening CHF.
Addition of ivabradine to carvedilol in patients with CHF resulted in a shorter BB uptitration period, higher final BB dose, greater HR reduction, and better exercise capacity.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure: Pharmacologic Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1223-301
- 2013 American College of Cardiology Foundation