The role of Ivabradine in hospitalized acute decompensated heart failure patients: a single center retrospective study

Background

Ivabradine is a heart rate (HR) lowering drug that acts by inhibiting the I(f) current in the sinoatrial node, it is indicated for chronic heart failure with reduced ejection fraction to reduce the deleterious effect of increased heart rate in decompensated patients. Data regarding the safety and efficacy of ivabradine in acute decompensated heart failure has been scarcely studied. This retrospective observational study aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure.

Methods

A total of 247 patients with acute decompensated heart failure on top of a chronic status admitted in the period from 1/1/2013 to 31/12/2023 who were already on guideline-directed treatment including a beta-blocker were included. Patients were divided into two groups, the first group (No-ivabradine) where patients continued the same dose of beta-blocker alone while the second group (ivabradine group) ivabradine 5 mg BID was added in addition to the same dose of beta-blocker. Patients with hemodynamic instabilities and those indicated to stop the beta blockers were excluded from the study. Propensity matching was performed to exclude confounding factors.

Results

There was no significant difference between groups regarding baseline patient characteristics, clinical and laboratory data except for a significantly lower average heart rate (76 ± 14 and 90 ± 22 bpm in ivabradine and no ivabradine groups, consecutively, P <0.001 before and after propensity matching). (Table 1)

Despite there was a trend towards shorter ICU stay and total hospital stay, there was no significant difference between both groups. Also, no significant difference as was noted regarding development of cardiogenic shock, in-hospital death, 30-days rehospitalization and 180-days rehospitalization. (Table 2)

Conclusion

In this retrospective cohort study that aimed to investigate the effects of ivabradine on morbidity and short-term mortality of hospitalized patients with acute decompensated heart failure. Ivabradine was associated with significantly lower average HR. However, there was no benefit in the reduction of ICU stay, hospital stay, rehospitalization and mortality rates.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.