The presentation addresses important questions around improving survival in HF patients. Each question is contemplated in different aspects:
- Is it a good idea to reduce HR?
- Heart rate reduction by 10 beats saves about 5KG ATP per day; heart rate is closely associated with life expectation
- Identification of heart rate associated loci and their effects on cardiac conduction and rhythm disorders
- Do we have the right drug?
- Mechanism of heart reduction by ivabradine
- Where to start, where to go?
- The Rotterdam Study: Resting heart rate and the risk of heart failure in healthy adults
- The DIAMOND study: Resting heart rate and mortality in heart failure post MI patients
- Metanalysis: effect of change in heart rate and achieved heart rate on clinical outcomes in HF
- SHIFT trial: baseline heart rate is a predictor of endpoints on placebo
- How to do it?
- Data from SHIFT study and a post-hoc analysis stating that chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure
- Short-term effects of ivabradine on LV function
- Short and long term hemodynamic effects of beta blockade differ
- Clinical problem solving: facilitating beta blocker uptitration
- What do the guidelines say?
- SHIFT trial and secondary analysis
- Ivabradine recommended as the anti-anginal of choice, on top of a beta blocker for heart failure patients with angina
The presentation ends with the following notes:
- Heart rate is dysregulated by genetic background and neuroendocrine activation
- It is not a physiological reaction to support cardiac output, target 50-60 bpm.