Pathophysiologic Insights into Heart Rate Reduction in Heart Failure: Implications in the Use of Beta-Blockers and Ivabradine

Author:

Kitai Takeshi,Tang W. H. Wilson

Publisher

Springer Science and Business Media LLC

Subject

Cardiology and Cardiovascular Medicine

Reference80 articles.

1. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–49.

2. Packer M. Pathophysiology of chronic heart failure. Lancet. 1992;340:88–92.

3. Swedberg K, Komajda M, Bohm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heart failure (shift): a randomised placebo-controlled study. Lancet. 2010;376:875–85. This landmark randomized trial of ivabradine in patients with heart failure confirmed the substudy findings of BEAUTIFUL in that it only included those with a heart rate above 70 bpm and found reduced cardiac events. The reduction in events was largely due to reduced heart failure hospitalizations and heart failure death.

4. Fox K, Ford I, Steg PG, Tendera M, Ferrari R. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (beautiful): a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372:807–16. This randomized trial found that ivabradine did not reduce mortality and cardiac events in patients with stable coronary artery disease and left ventricular systolic dysfunction, but appeared to be effective in the subgroup with a heart rate above 70 bpm.

5. Bohm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A, et al. Heart rate as a risk factor in chronic heart failure (shift): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet. 2010;376:886–94. This substudy of the SHIFT trial found that patients with highest heart rates (≥87 bpm) were at more than twofold higher risk for cardiac events than were patients with the lowest heart rates (<72 bpm). The risks of cardiac events increased by 3 % with every beat increase from baseline heart rate and 16 % for every 5-bpm increase.

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