الملخص الإنجليزي
Background: Increased heart rate (HR) is a significant predictor of death and hospitalization in heart failure patients. Risk increases directly with increasing HR above ~60 beat/minutes (bpm). These lead to the hypothesis that lowering heart rate with the If inhibitor Ivabradine could be beneficial for cardiac function and clinical outcomes in heart failure patients. Aim: compare the effect of Carvedilol/Ivabradine combination versus Carvedilol alone on HR, quality of life, morbidity and mortality in patients with stable ischemic heart failure (IHF). Subjects: 58 Stable IHF patients enrolled in this study between January and May/2012 were randomly allocated to 2 groups: carvedilol up to 25 mg twice daily (n=30) (group I) and carvedilol/ivabradine up to 25/7.5 mg twice daily (n=28) (group II). The duration of follow-up was 3 months. Methods: patients were screened for inclusion and exclusion criteria. After given informed consent, all patients were subjected at baseline and at end of follow-up to electrocardiogram (ECG), echocardiograph (ECHO), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Study visits were programmed at two weeks, one, and three months. Drug therapy was titrated based on reaching the target HR between 50-60 bpm or reaching the maximum dose of drugs in both groups. Results; The average daily dose of ivabradine was 5.8 mg. The average daily dose of carvedilol was 16.2 mg and 11.4 mg in group I, and in group II respectively. Resting HR decreased in both groups from 82.6+ 12 to 72.9+ 12.7 bpm in group 1 (P=0.03); and from 85.3+9.7 to 68.5+ 9.4 bpm in group 2 (P=0.03). The reduction in HR was significantly higher on combination therapy (p=0.03). There was a significant increases in left ventricular ejection fraction (EF) in group 2 by 4.65.9% (P=0.01), whereas no significant change was observed in group 1. The reduction in HR due to ivabradine was associated with pronounced increment in health related quality of life and reduction of incidence of hospital admission for worsening heart failure. Ivabradine in combination with carvedilol was associated with non significant asymptomatic bradycardia (P=0.08). Conclusion: Combining ivabradine to carvedilol in stable ischemic heart failure patients with heart rate faster than 70 bpm was associated with marked HR reduction, improvement of quality of life. Risk of bradycardia should be taken when ivabradine is used with carvedilol.
