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Is There a Role for Ivabradine in the Contemporary Management of Patients with Chronic Heart Failure in Academic and Community Heart Failure Clinics in Canada?

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Abstract

Introduction

In patients with heart failure (HF) and reduced ejection fraction, increased heart rate (HR) is an independent risk factor for adverse outcomes. In systolic HF treatment with the If inhibitor ivabradine trial (SHIFT), Ivabradine improved survival when added to conventional treatment including β-blockers. However, the extent of benefit in the real world is unclear. We examined the characteristics of patients on guideline-directed therapy and determined who had SHIFT-like characteristics.

Methods

A total of 1096 patients with chronic HF were reviewed from June 2014 to April 2015 in two HF clinics in Toronto: an academic institution (AI), and a community hospital (CH) clinic. SHIFT-like characteristics [left ventricular ejection fraction (LVEF) ≤35%; sinus rhythm; and HR ≥ 70 bpm] were described.

Results

For all patients, mean age was 75 ± 13 years, overall LVEF was 44 ± 15%, AI less than CH (41.9 ± 14.0% vs. 45.7 ± 15.0%; p < 0.0001). More than two-thirds of patients in both groups were on β-blockers; with less than one-third at target dose. The proportion of patients with SHIFT-like characteristics was 8.4% AI and 11.7% CH, respectively (p = 0.0658).

Conclusion

In HF clinics from both academic and community hospitals in Toronto, up-titration in the dose of β-blockers and other guideline therapy can be improved on. A small proportion of patients with HF and SHIFT-like characteristics may potentially benefit from the addition of Ivabradine, just approved in Canada; this number will be further reduced if target dosage for β-blockers is achieved.

Funding

Servier Inc.

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Acknowledgements

Sponsorship and article processing charges for this study were funded by an unrestricted research grant from Servier Inc. No funding was received for medical writing assistance. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Compliance with Ethics Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013.

Disclosures

Sherryn Roth, Carlos Fernando, Sadia Azeem and Gordon W. Moe have nothing to disclose.

Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. The Scarborough Hospital, General Division, Scarborough, ON, Canada

    Sherryn Roth & Sadia Azeem

  2. Department of Medicine, Division of Cardiology, St Michael’s Hospital, Toronto, ON, Canada

    Carlos Fernando & Gordon W. Moe

  3. Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Sherryn Roth & Gordon W. Moe

  4. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sherryn Roth

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  1. Sherryn Roth
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  2. Carlos Fernando
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Correspondence to Gordon W. Moe.

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Roth, S., Fernando, C., Azeem, S. et al. Is There a Role for Ivabradine in the Contemporary Management of Patients with Chronic Heart Failure in Academic and Community Heart Failure Clinics in Canada?. Adv Ther 34, 1340–1348 (2017). https://doi.org/10.1007/s12325-017-0529-4

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