Ivabradine in the treatment of stable angina – insights from cohort studies in clinical practice
Abstract
Heart rate is increasingly recognized as an important therapeutic target in cardiovascular disease. Elevated heart rate impairs myocardial oxygen balance by increasing oxygen demand and reducing oxygen supply of the myocardium (by shortening of diastolic time).
The If channel inhibitor and heart rate reducing agent ivabradine has demonstrated marked anti-anginal efficacy in several clinical trials as either monotherapy in patients not able to tolerate treatment with beta blockers or also in combination with beta blockers. Ivabradine is indicated and approved for use in angina patients in the European Union for several years now. Since 2012, the drug is also licensed for treatment of chronic systolic heart failure. Apart from randomized controlled clinical trials in angina patients, also a number of non-interventional, prospective cohort studies have been conducted to analyze the use, effectiveness and safety of ivabradine in daily clinical practice. The advantage of this kind of observational cohorts is the possible inclusion of relatively large numbers of patients that are usually excluded from controlled clinical trials, e.g. elderly patients with extensive comorbidities. This offers an opportunity to close a gap of evidence that could not be addressed by randomized clinical trials, also reflecting much closer the everyday use of the drug in daily practice routine conditions.
The aim of this paper is to review the currently published evidence of ivabradine use in angina patients in routine practice, with a special focus on anti-anginal effectiveness of the drug in relevant subgroups of patients that may have not been addressed adequately so far in clinical trials.Keywords
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DOI: http://dx.doi.org/10.18103/imr.v0i5.104
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