Abstract 18267: Ivabradine in Acute Heart Failure: A Therapeutic Means for Effective Heart Rate Control

Autor: Jens Treptau, Ole Jeske, Christian Napp, Akshay Menon, Bernhard Schieffer, Andreas Schaefer, Johann Bauersachs, Joern Tongers
Rok vydání: 2015
Předmět:
Zdroj: Circulation. 132
ISSN: 1524-4539
0009-7322
DOI: 10.1161/circ.132.suppl_3.18267
Popis: Background: In acute cardiac care elevated heart rates are related to morbidity and mortality. Heart rate control may be beneficial in critically ill patients, but heart rate-reducing ß-blockers or antiarrhythmic drugs alter inotropy and hemodynamics. We evaluated the use of ivabradine for heart rate control in acute heart failure with persistently elevated heart rates. Methods/Results: After acute ICU-admission for heart failure/cardiogenic shock, 68 patients (age 57+/-16 yrs, 49 male/19 female) were treated with ivabradine for heart rate control. ICU-admission resulted from myocardial ischemia (65%), decompensated heart failure (17%), valvular heart disease (4%) or other pathologies (7%); 17% of these patients had been resuscitated. Patients were critically ill: 29 required ≥1 catecholamine, 21 mechanical ventilation, 5 mechanical circulatory support (3 Impella microaxial pump, 1 extracorporal membrane oxygenation, 1 combined support), 4 received hemodialysis, and many a calcium sensitizer. In case of a persistently elevated heart rate after a 24hrs run-in phase (cut-off: >80bpm, mean 100±15 bpm), ivabradine was initiated on-top of standard care (dosing: 5 mg/d, n=15; 10 mg/d, n=53). In 10 patients, the ivabradine dose could be increased, while in only 3 patients the dose had to be reduced or therapy terminated. Ivabradine treatment resulted in a significant reduction of heart rate (baseline 100±25 bpm; ICU day-2 82±12 bpm, p Conclusion: Early addition of ivabradine to standard intensive cardiac care is efficacious and safe in controlling elevated heart rates in acute heart failure.
Databáze: OpenAIRE
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