Optimization of heart rate lowering therapy in hospitalized patients with heart failure: Insights from the Optimize Heart Failure Care Program

Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality an...

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Published in:	International journal of cardiology Vol. 260; pp. 113 - 117
Main Authors:	Lopatin, Yuri M., Cowie, Martin R., Grebennikova, Anna A., Sisakian, Hamayak S., Pagava, Zurab M., Hayrapetyan, Hamlet G., Abdullaev, Timur A., Voronkov, Leonid G., Chesnikova, Anna I., Tseluyko, Vira I., Tarlovskaya, Ekaterina I., Dadashova, Gülnaz M., Berkinbaev, Salim F., Glezer, Maria G., Koziolova, Natalia A., Rakisheva, Amina G., Kipiani, Zviad V., Kurlyanskaya, Alena K.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-06-2018
Subjects:	Adrenergic beta-Antagonists - administration & dosage Aged Benzazepines - administration & dosage Beta blockers Cardiovascular Agents - administration & dosage Female Follow-Up Studies Heart failure Heart Failure - drug therapy Heart Failure - physiopathology Heart Rate - drug effects Heart Rate - physiology Hospitalization Hospitalization - trends Humans Ivabradine Male Middle Aged Mortality Optimize Retrospective Studies Heart failure Hospitalization Beta blockers Mortality Ivabradine Optimize
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Summary:	Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32–0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy. •Hospitalized heart failure patients with heart rate≥70 bpm have a higher mortality risk.•In those patients beta blockers (BB) + ivabradine reduced 12-month mortality/rehospitalization vs BB alone.•A large clinical trial is needed to confirm the advantages of this strategy
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0167-5273 1874-1754
DOI:	10.1016/j.ijcard.2017.12.093