Reduction of mortality in heart failure through effective reduction of heart rate – the role of ivabradine Review article
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Abstract
Numerous data from pathophysiological, epidemiological and observational studies support the idea of using drugs slowing down the heart rate in therapy of cardiovascular diseases. Clinical trial data suggest that heart rate reduction itself is an important mechanism of benefit of β-blockers and other heart-rate lowering drugs used after acute myocardial infarction, in chronic heart failure, and in stable angina pectoris. However, methods of pharmacological heart rate reduction based on agents such as β-blockers, digoxin or calcium antagonist treatment are associated with various side effects. In daily practice there was no drug that selectively reducing heart rate without affecting other aspects of cardiac function. Ivabradine is the first modern drug selectively reducing heart rate by inhibiting If ion channels of the sinus node. It has been included in recent heart failure guidelines as preferred agent for sinus rate control when 70 bpm or more in patients in NYHA class II–IV. The drug is an important step forward in the treatment of the myriad of patients with chronic heart failure and coronary artery disease at uncontrolled heart rate, raising hopes to improve prognosis and reduce mortality.
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