Elderly patient with heart failure and preserved ejection fraction: effects of ivabradine

Approximately half of patients with a diagnosis of heart failure have a normal left ventricular ejection fraction. This patients are usually older, female and with comorbidities such as hypertension, diabetes and renal failure. Unfortunately, no pharmacologic therapy has been shown to be effective in improving outcomes in patients with Heart Failure with a preserved left ventricular Ejection Fraction (HFNEF). On this background, it is assumed that a reduction in Heart Rate (HR) could be advantageous. The use of ivabradine is never been tested in elderly patients with HFNEF.

Purpose: To evaluate safety and efficacy of ivabradine in improving diastolic function as well as symptoms of elederly patients (aged 75-85 yrs) with HFNEF. We enrolled 106 patients (62 females, mean age 79±4 years), NYHA class II (28 pts) and III (78 pts), in sinus rhythm with left ventricle ejection fraction> 50%. Patients were treated with ivabradine up to 7.5 mg BID. Patients undergone echocardiographic examination at baseline, and at 1, 3 and 6 months. Four patients were lost at follow-up and were excluded from analysis. The dose of 7.5 mg BID was achieved by 66% of pts. The HR decreased significantly after 1 month with a plateau at 3 months and echocardiographic parameters improved likewise. Twenty pts in NYHA class II step down of a class. Fifty-six pts in III class step to II and 6 in I class. There were 2 case of symptomatic bradycardia that required down-titration.

Conclusions: In elderly patients with HFNEF, ivabradine has proved feasible and effective in improving symptoms and echocardiographic diastolic function, together with a significant reduction of HR.

Source: congress365.escardio.org