Initiating ivabradine during hospitalization in patients with acute heart failure: A real-world experience in China

Abstract

Background: Initiating ivabradine in acute heart failure (HF) is still controversial.

Hypothesis: Ivabradine might be effective to be added in acute but hemodynamically stable HF.

Methods: A retrospective cohort of hemodynamically stable acute HF patients was enrolled from January 2018 to January 2020 and followed until July 2020. The primary endpoints were all-cause mortality and rehospitalization for HF. Secondary endpoints included heart rate (HR), cardiac function measured by New York Heart Association (NYHA) class, and left ventricular ejection fraction (LVEF) and adverse events, which were compared between patients with or without ivabradine.

Results: A total of 126 patients were enrolled (50 males, median age 54 years, 81% with decompensated HF, median follow-up of 9 months). In patients treated with ivabradine, although baseline HRs were higher than the reference group (96 vs. 80 bpm), they were comparable after 3 months; more patients tolerated high doses of β-blockers (27% vs. 7.9%), improved to NYHA class I function (55.6% vs. 23.8%) and exhibited normal LVEFs (37.8% vs. 14.3%) than the reference group (all p < .05). Ivabradine was associated with a significant reduction of rehospitalization for HF than the reference group (25.4% vs.61.9%), with longer event-free survival times (hazard ratio: 0.45, 95% confidence interval [CI]: 0.25-0.79), and was related with primary endpoints negatively (hazard ratio 0.51, 95% CI: 0.28-0.91) (all p < .05).

Conclusion: In patients with acute but hemodynamically stable HF, ivabradine may significantly reduce HR, improve cardiac function, and reduce HF rehospitalization.

Keywords: acute heart failure; ivabradine; outcome.

Figure 1

Descriptions of ivabradine and β‐blockers during the follow‐up. χ ² and Fisher's exact test. (A) Durations from admission to adding ivabradine. (B) Initiated dose and maximal dose of ivabradine at the 3‐month follow‐up. (C) The percentage comparisons of different doses of β‐blockers between groups. (D) Percentage comparisons of HF patients with a high dose of β‐blockers at discharge, 3‐month, and last follow‐up. HF, heart failure.

Figure 2

Comparisons between baseline and follow‐up. Expressed as percentages of patients with heart rates ≥ 70 bpm (A), as (median [IQR]) for heart rates (B), as mean (SD) for systolic blood pressure (C), and diastolic blood pressure (D), as distributions of NYHA classifications (E), and as distributions of HF classifications (LVEF < 40%, LVEF 40%–50%, and LVEF > 50%) (F). HF, heart failure; IQR, interquartile range; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.

Figure 3

Outcome analyses of hospitalized patients with acute heart failure (HF). Multivariate Cox regression and Kaplan–Meier survival analysis. Less rehospitalization for HF (A), longer event‐free survival time (B), and reduced risk of primary outcomes (C) in the group with ivabradine. AIC, Akaike information criterion; CI, confidence interval; eGFR, estimated glomerular filtration rate.