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Evidence summaries

Ivabradine as Adjuvant Treatment for Chronic Heart Failure

Long-term (≥ 6 months) treatment with ivabradine appears not to reduce mortality from cardiovascular causes or rate of serious adverse events in participants with heart failure with reduced ejection fraction (HFrEF) compared to placebo/usual care/no treatment. Level of evidence: "B"

The quality of evidence is downgraded by indirectness (differences between the population of interest and those studied: male predominance).

Summary

A Cochrane review [Abstract] 1 included 19 studies with a total of 19 628 subjects (mean age 60.8 years, 69% male). Only few studies contributed data to meta-analyses due to substantial clinical heterogeneity in type of heart failure, heterogeneity regarding ivabradine treatment, and substantial heterogeneity in definition and measurement of outcome parameters. It was possible to perform 2 meta-analyses focusing on participants with heart failure with a reduced ejection fraction (HFrEF) and long-term ivabradine treatment.

There was no difference in mortality from cardiovascular causes (RR 0.99, 95% CI 0.88 to 1.11; 3 studies, n=17 676) between ivabradine and placebo/usual care/no treatment. There was no difference in rate of serious adverse events between long-term ivabradine compared with placebo, usual care, or no treatment (RR 0.96, 95% CI 0.92 to 1.00; 2 studies, n=17 399). It was not possible to perform meta-analysis for all other outcomes.

Clinical comments

Note

Date of latest search:

    References

    • Benstoem C, Kalvelage C, Breuer T et al. Ivabradine as adjuvant treatment for chronic heart failure. Cochrane Database Syst Rev 2020;(11):CD013004. [PubMed]

Primary/Secondary Keywords