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Ivabradine for the treatment of stable angina pectoris in octogenarians

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Abstract

Purpose

In patients >80 years (octogenarians), there is an increased incidence of bradycardia due to age-related alteration of the sinus node, AV node, and the conduction system. Therefore, the treatment of angina pectoris with beta-blockers may be limited by bradycardia. The REDUCTION multicenter study evaluated the efficacy of ivabradine in stable angina pectoris in everyday practice. This subgroup analysis evaluated the efficacy and safety of ivabradine in octogenarians.

Methods

A total of 4,954 patients were included in the REDUCTION study for treatment of stable angina pectoris. This group included 382 octogenarians (mean age 83 ± 2.9 years) who were followed up over 4 months. Patients were treated with ivabradine in flexible doses (2.5, 5, or 7.5 mg bid). Heart rate (HR), angina pectoris attacks, nitrate consumption, overall efficacy, and tolerance were evaluated.

Results

After 4 months of treatment with ivabradine, HR was reduced by 12.0 ± 12.0 bpm from 83.0 ± 15.4 to 71.0 ± 10.1 bpm (p < 0.0001). Angina pectoris attacks were reduced from 3.0 ± 4.6 to 0.8 ± 1.8 per week (p < 0.0001). Consumption of nitrates decreased from 4.2 ± 5.1 to 1.2 ± 2.7 (p < 0.0001). Four patients reported suspected adverse drug reactions. In one patient a syncope occurred. There was no symptomatic bradycardia reported. Efficacy and tolerance were assessed as ‘very good/good’ for 95 and 99%.

Conclusions

The results demonstrate that ivabradine efficiently reduces HR, number of angina attacks, and nitrate consumption in octogenarian patients. The treatment was safe and well tolerated without relevant bradycardia.

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Acknowledgments

The authors thank Dieter Schremmer from the ‘Gesellschaft für Therapieforschung’ in Munich, Germany, for his substantive support of the statistical analysis, and all investigators for their contributions to the study. The investigators participated were J. Taggeselle, L. Feß, R. Aubele, N. Hassler, K. Hofmann, V. Adelberger, T. Arnold, B. Holz, M. Hwaidi, H.-D. Kombächer, R. Meysing, S. Appel, J. Bazowski, R. Bernauer, H. Böneke, M. Braun, E. Daelmann, M. Deißner, S. Duddy, M.-A. Eisenbarth, H. Fissan, C. Freese, G. Gölz, M. Gutting, K. Hallbaum, M. Hilgedieck, J.-A. Hintze, H. Hohensee, T. Hohenstatt, O. Khan, H.-H. Knäbchen, A. Krämer, K. Krämer, R. Lange, A. Levertov, H. Littwitz, U. Meyer, K. Müller, L. Rokitzki, C. Ruhnau, K. Rybak, R. Schmitt, A. Spingler, H. Stellmach, R. Tietze, W. Türk, R. Vormann, T.-A. Wiegmann, G. Will, E. Wüstenberg, J. Zivojinovic. The list of the further investigators is available from the corresponding author.

Conflict of interest

RK’s and TM’s participation at scientific congresses has been supported by Servier Munich, Deutschland. TM is member of the advisory board. JK has no conflict of interest.

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Authors and Affiliations

  1. Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany

    Ralf Koester, Jan Kaehler & Thomas Meinertz

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  1. Ralf Koester
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  2. Jan Kaehler
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  3. Thomas Meinertz
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Correspondence to Ralf Koester.

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On behalf of the REDUCTION Study Investigators.

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Koester, R., Kaehler, J. & Meinertz, T. Ivabradine for the treatment of stable angina pectoris in octogenarians. Clin Res Cardiol 100, 121–128 (2011). https://doi.org/10.1007/s00392-010-0220-0

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  • DOI: https://doi.org/10.1007/s00392-010-0220-0

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