Abstract 18267: Ivabradine in Acute Heart Failure: A Therapeutic Means for Effective Heart Rate Control
Background: In acute cardiac care elevated heart rates are related to morbidity and mortality. Heart rate control may be beneficial in critically ill patients, but heart rate-reducing ß-blockers or antiarrhythmic drugs alter inotropy and hemodynamics. We evaluated the use of ivabradine for heart rate control in acute heart failure with persistently elevated heart rates.
Methods/Results: After acute ICU-admission for heart failure/cardiogenic shock, 68 patients (age 57+/-16 yrs, 49 male/19 female) were treated with ivabradine for heart rate control. ICU-admission resulted from myocardial ischemia (65%), decompensated heart failure (17%), valvular heart disease (4%) or other pathologies (7%); 17% of these patients had been resuscitated. Patients were critically ill: 29 required ≥1 catecholamine, 21 mechanical ventilation, 5 mechanical circulatory support (3 Impella microaxial pump, 1 extracorporal membrane oxygenation, 1 combined support), 4 received hemodialysis, and many a calcium sensitizer. In case of a persistently elevated heart rate after a 24hrs run-in phase (cut-off: >80bpm, mean 100±15 bpm), ivabradine was initiated on-top of standard care (dosing: 5 mg/d, n=15; 10 mg/d, n=53). In 10 patients, the ivabradine dose could be increased, while in only 3 patients the dose had to be reduced or therapy terminated. Ivabradine treatment resulted in a significant reduction of heart rate (baseline 100±25 bpm; ICU day-2 82±12 bpm, p<0.05; hospital discharge, 79±16 bpm, p<0.01) without hemodynamic alteration (systolic/diastolic blood pressure at discharge: 111±16/63±10 mmHg). Overall ivabradine was well tolerated. Apart from one individual, all patients survived the intrahospital phase. Five patients were successfully bridged to LVAD-implantation. Follow-up revealed that ivabradine was continued in 52% and 43% of patients 30 and 180 days after hospital discharge. No serious adverse events were reported. Three patients had to be readmitted with acute cardiovascular events within 30 days and another 3 within 180 days of follow-up, whereas 7 patients died during 180-days follow-up.
Conclusion: Early addition of ivabradine to standard intensive cardiac care is efficacious and safe in controlling elevated heart rates in acute heart failure.
Author Disclosures: J. Treptau: None. O. Jeske: None. C. Napp: None. A. Menon: None. B. Schieffer: None. A. Schaefer: None. J. Bauersachs: None. J. Tongers: None.
- © 2015 by American Heart Association, Inc.