Outcomes in acute decompensated chronic heart failure patients discharged with and without ivabradine: Advantages beyond heart rate control

Abstract

Background and Aim: Ivabradine is indicated in chronic heart failure (HF) and reduced ejection fraction (EF) of < 35% and resting heart rate (HR) of > 70 bpm. However, role of Ivabradine in acute decompensated chronic HF (ADCHF) is not well known. The aim of this study was to evaluate one-year outcomes of ADCHF patients discharged with and without Ivabradine. Materials and Methods: This is a prospective observational cohort study of ADCHF patients from January 2016 to January 2018. Main exclusion criteria was new onset de-novo acute HF, those with EF > 50% and atrial fibrillation. Data were analysed from 130 patients who were discharged with (62 patients) or without Ivabradine (68 patients). The primary end points were one-year re-hospitalization and cardiovascular mortality between two groups. Results: The mean age of patients were 56 ± 15 years and 61 ± 17 years between Ivabradine and Non-ivabradine groups. EF upon discharge was 37.48% ± 5.34% vs 40.01% ± 8. 12%, with p-value of 0.036. At discharge, higher HR was noted in patients with Ivabradine 84 ± 13 bpm compared to 77.84 ± 12. 13 bpm in patients without Ivabradine (p-value = 0.006). After a year, HR in Ivabradine group was low compared to non-Ivabradine group, but was not statistically significant, 66.15 ± 8 vs. 69.29 ± 11.3 bpm, respectively. In the Ivabradine group 27.4% of patients visited emergency room (ER) more than once compared to 60.2 % without Ivabradine (p-value = 0.0001). 9.7% of patients in Ivabradine group required one readmission compared to 55.9% without Ivabradine (p-value = 0.0001). Conclusions: In ADCHF patients there was significant reduction in ER room visit and re-admission rate in patients discharged with Ivabradine. Hence Ivabradine therapy may be considered in patients with ADCHF with EF < 50% and HR > 70 bpm to prevent re-hospitalization and save hospitalization costs.