Ivabradine may not benefit certain heart failure patients

Researchers have completed a randomized clinical trial in patients with heart failure with preserved ejection fraction (HFpEF), which currently has no effective treatment for reducing morbidity and mortality.

Elevated heart rate is a predictive factor of worse outcomes and increased mortality in patients with HFpEF, but this trial found that heart rate reduction with the drug ivabradine does not improve outcomes. The findings do not support the use of ivabradine in these patients. Previous research has found that ivabradine can benefit patients with heart failure with reduced ejection fraction, however.

“Potential explanations for failure are lack of sufficient power since recruitment was interrupted due to difficulties in finding patients, and the idea that heart rate lowering is beneficial in this condition could be wrong if patients have extensive fibrosis and thus no reserve in stroke volume. In that case, changes in cardiac output are totally dependent of heart rate, and reducing heart rate in this context could be detrimental,” said Prof. Michel Komajda, lead author of the European Journal of Heart Failure study.