Heart Rate Reduction with Ivabradine in Patients with Acute Decompensated Systolic Heart Failure

In patients with acute decompensated systolic heart failure (ADSHF) high resting heart rate (HR) could be either a compensatory mechanism or contribute to worsening heart failure. The aim of this study was to evaluate, in patients with ADSHF and resting HR > 70 bpm, the early (within 24 h) and late (at discharge) effects of oral administration of ivabradine on HR reduction. Ten consecutive patients with ADSHF, left ventricular ejection fraction < 40 % and HR > 70 bpm, without other acute conditions or inotropic therapy, began open-label treatment with oral ivabradine according to a pre-established Heart Failure Unit protocol. We obtained clinical and laboratory data at four periods: admission (T0), immediately before initiation of ivabradine (T2), 24 h after initiation of ivabradine (T3), and at discharge (T4). Ivabradine was administered in 60 % of the patients before the second day. HR decreased 10.7 +/- A 7.2 bpm at T3 (p < 0.001) and 16.3 +/- A 8.2 bpm at T4 (p = 0.002). The systolic blood pressure decreased at T3 (p = 0.012), returning to baseline values at T4. There was no change in diastolic and mean blood pressure. New York Heart Association (NYHA) class improvement by two levels was associated with lower HR at T4 (p = 0.033). HR and N-terminal pro-brain natriuretic peptide (Nt-ProBNP) at baseline correlated significantly [Spearman correlation coefficient (rs) = 0.789, p = 0.013]. Total Nt-ProBNP reduction correlated with the HR before (r = 0.762, p = 0.028) and after (T3: r = 0.647, p = 0.083; T4: r = 0.738, p = 0.037) ivabradine addition. In the present cohort of patients with ADSHF and HR > 70 bpm, the selective reduction of HR with oral ivabradine was safe and efficient.