The European Heart Journal has featured a study aimed at determining the proportion of heart failure patients that might be suitable for treatment with ivabradine. The SHIFT study had previously suggested that ivabradine was beneficial when added to conventional treatment including a beta-blocker in heart failure patients in sinus rhythm whose resting heart rates remained 70 beats per minute (bpm) or greater and who had worse than moderate left ventricular impairment. 

The primary cohort included 2211 patients with a left ventricular ejection fraction (LVEF) of 50% or less. Patients were seen at baseline, then reviewed at 4 and 12 months. ‘Suitability’ for ivabradine was assessed as: LVEF 35% or less, sinus rhythm and a resting heart rate of 70 bpm or greater.

The following results were reported:

• The proportion of patients who were ‘suitable’ for ivabradine therapy fell from 19.4% (n=429) at baseline, to 14.1% (n=185) at 4 months and finally 9% (n=82) by the 12-month clinic visit.

• The proportion fell to 5.3% (n=48) if only patients with New York Heart Association class I symptoms and/or no β-blocker therapy were excluded.

The researchers concluded that after uptitration of heart failure medications, the number of patients ‘suitable’ for ivabradine therapy was small. The researchers also concluded that beta-blocker therapy should be commenced and titrated, and the decision to add ivabradine should be made after allowing adequate time to uptitrate conventional medical therapy.