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Beta-Blockers and Ivabradine in Chronic Heart Failure: From Clinical Trials to Clinical Practice

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An Erratum to this article was published on 24 July 2014

Abstract

Beta-blockers have become one of the cornerstones of treatment of patients with heart failure (HF) and depressed left ventricular function, but in clinical practice only 30–35 % of patients achieve the therapeutic target dose as established in randomized clinical trials. Moreover, high resting heart rate (HR) has emerged as a simple but relevant risk factor for cardiovascular events, including coronary artery disease and HF; also, it was found to have an independent prognostic value in patients with HF. Evidence that HR could be considered a good parameter to evaluate the quality of treatment in patients with HF has been suggested; of note, many patients maintain a resting HR ≥70 beats per minute despite optimal beta-blocker therapy. In recent years, a new drug able to reduce HR, ivabradine, has been introduced in clinical practice, and its use in the clinical setting of HF patients has been recommended by current European Society of Cardiology (ESC) guidelines. Here we review the evidence of the prognostic role of HR in systolic HF and the potential relationship between HR lowering and the beneficial effects of beta-blockers; we will also analyze the reasons why an appropriate use of these drugs is seldom achieved in clinical practice, and review the evidence for the use of ivabradine in systolic HF in the clinical setting.

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No external funding was used in the preparation of this review and none of the authors have any potential conflict of interest that might be relevant to the contents of this review.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore, Rome, Italy

    Antonino Di Franco, Stefano Figliozzi, Rossella Parrinello & Gaetano A. Lanza

  2. Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Via Messina Marine n. 197, 90123, Palermo, Italy

    Filippo M. Sarullo & Ylenia Salerno

  3. Division of Cardiology “Paolo Borsellino”, G.F. Ingrassia Hospital, Palermo, Italy

    Pietro Di Pasquale

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  1. Antonino Di Franco
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Di Franco, A., Sarullo, F.M., Salerno, Y. et al. Beta-Blockers and Ivabradine in Chronic Heart Failure: From Clinical Trials to Clinical Practice. Am J Cardiovasc Drugs 14, 101–110 (2014). https://doi.org/10.1007/s40256-013-0057-9

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