Abstract

Heart rate (Hr) has prognostic value in patients with heart failure, depressed ejection fraction (HFrEF) and sinus rhythm. Objective: Is to analyze the effect of the early co-administration of ivabradine added to beta-blockers (intervention group) versus only beta blockers (control group) in patients hospitalized with HFrEF on Hr and clinical and functional outcomes at long term. Methods: We have analysed the one-year follow-up results of a randomized study comparing these two treatment strategies after hospitalization for acute HFrEF, sinus rhythm and Hr > 70 bpm, following the usual titration doses of both drugs. Results: 33 patients in the intervention group and 38 in Control group were included. Hr at 28 days was lower in the intervention group (64.3 ± 7.5 versus 70.3 ± 9.3 bpm, p = 0.01), keeping this difference at one year (61.8 ± 5.5 versus 68.4 ± 9.3 bpm, p = 0.01). The doses of beta-blockers at one year were similar in both groups. The EF at one year was significantly higher in the intervention group (48.2 ± 17 versus 41.8 ± 10%, p = 0.002). The probability of cardiovascular death was 26% lower in the ivabradine group, although without reaching statistical significance (HR 0.74; IC 95%: 0.12-4.43). No severe side effects drugs were observed. Conclusion: Early co-administration of ivabradine and beta-blockers during hospital admission for acute HFrEF, sinus rhythm and Hr > 70 bpm is feasible and safe, and it produced a significant decrease in Hr at 28 days post-discharge and at 1 year after hospital discharge, as well as an improvement in left ventricular systolic function.

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