The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients
Abstract Aims Ivabradine has been used in patients who have chronic heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant sinus heart rate ≥70 bpm. This administration for acute HFrEF remains a concern. This study used a real‐world multicentre database to investigate the effects...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13536 |
| _version_ | 1818394483291586560 |
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| author | Chia‐Te Liao Jin‐Long Huang Huai‐Wen Liang Fa‐Po Chung Ying‐Hsiang Lee Po‐Lin Lin Wei‐Ru Chiou Wen‐Yu Lin Chien‐Yi Hsu Hung‐Yu Chang |
| author_facet | Chia‐Te Liao Jin‐Long Huang Huai‐Wen Liang Fa‐Po Chung Ying‐Hsiang Lee Po‐Lin Lin Wei‐Ru Chiou Wen‐Yu Lin Chien‐Yi Hsu Hung‐Yu Chang |
| author_sort | Chia‐Te Liao |
| collection | DOAJ |
| description | Abstract Aims Ivabradine has been used in patients who have chronic heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant sinus heart rate ≥70 bpm. This administration for acute HFrEF remains a concern. This study used a real‐world multicentre database to investigate the effects of ivabradine among patients with acute decompensated HFrEF before discharge. Methods and results This study retrospectively identified patients with acute decompensated HFrEF who were administered ivabradine at discharge from two multicentre HF databases. Propensity score matching was performed to adjust for confounders. Cardiovascular mortality, all‐cause mortality, and recurrent HF rehospitalization risks were then compared between those with and without ivabradine treatment. After 1:2 propensity score matching, 876 patients (age, 60.7 ± 14.6 years; female, 23.2%; left ventricular ejection fraction, 28.2% ± 7.8%; and heart rate at discharge, 84.3 ± 13.8 bpm) were included in the final analysis, including 292 and 584 patients with and without ivabradine treatment at discharge, respectively. No significant differences were observed in baseline characteristics between the two groups. At 1 year follow‐up, patients in the ivabradine group had significantly lower heart rates (77.6 ± 14.7 vs. 81.1 ± 16.3 bpm; P = 0.005) and lower HF severity symptoms (New York Heart Association Functional class, 2.1 ± 0.7 vs. 2.3 ± 0.9; P < 0.001) than those from the non‐ivabradine group. Ivabradine users had significantly lower risks of 1 year cardiovascular mortality (5.8 vs. 12.2 per 100‐person year; P = 0.003), all‐cause mortality (7.2 vs. 14.0 per 100‐person year; P = 0.003), and total HF rehospitalization (42.3 vs. 72.6 per 100‐person year; P < 0.001) than non‐ivabradine users. Following multivariate analysis, the predischarge prescription of ivabradine remained independently associated with lower 1 year all‐cause mortality (hazard ratio, 0.45; 95% confidence interval, 0.28–0.74; P = 0.002) and cardiovascular mortality (hazard ratio, 0.41; 95% confidence interval, 0.24–0.72; P = 0.002). Conclusions The current study findings suggest that ivabradine treatment is associated with reduced risks of cardiovascular mortality, all‐cause mortality, and HF rehospitalization within 1 year among patients with acute decompensated HFrEF in real‐world populations. |
| first_indexed | 2024-12-14T06:01:55Z |
| format | Article |
| id | doaj.art-1a4b0041385f427cb641ad8366560ce5 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T06:01:55Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-1a4b0041385f427cb641ad8366560ce52022-12-21T23:14:23ZengWileyESC Heart Failure2055-58222021-10-01854199421010.1002/ehf2.13536The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patientsChia‐Te Liao0Jin‐Long Huang1Huai‐Wen Liang2Fa‐Po Chung3Ying‐Hsiang Lee4Po‐Lin Lin5Wei‐Ru Chiou6Wen‐Yu Lin7Chien‐Yi Hsu8Hung‐Yu Chang9Division of Cardiology Chi‐Mei Medical Center Tainan TaiwanCardiovascular Center Taichung Veterans General Hospital Taichung TaiwanDivision of Cardiology, Department of Internal Medicine, E‐Da hospital I‐Shou University Kaohsiung TaiwanFaculty of Medicine, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanDepartment of Medicine Mackay Medical College New Taipei TaiwanDepartment of Medicine Mackay Medical College New Taipei TaiwanDepartment of Medicine Mackay Medical College New Taipei TaiwanDivision of Cardiology, Department of Medicine, Tri‐Service General Hospital National Defense Medical Center Taipei TaiwanFaculty of Medicine, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanFaculty of Medicine, School of Medicine National Yang Ming Chiao Tung University Taipei TaiwanAbstract Aims Ivabradine has been used in patients who have chronic heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant sinus heart rate ≥70 bpm. This administration for acute HFrEF remains a concern. This study used a real‐world multicentre database to investigate the effects of ivabradine among patients with acute decompensated HFrEF before discharge. Methods and results This study retrospectively identified patients with acute decompensated HFrEF who were administered ivabradine at discharge from two multicentre HF databases. Propensity score matching was performed to adjust for confounders. Cardiovascular mortality, all‐cause mortality, and recurrent HF rehospitalization risks were then compared between those with and without ivabradine treatment. After 1:2 propensity score matching, 876 patients (age, 60.7 ± 14.6 years; female, 23.2%; left ventricular ejection fraction, 28.2% ± 7.8%; and heart rate at discharge, 84.3 ± 13.8 bpm) were included in the final analysis, including 292 and 584 patients with and without ivabradine treatment at discharge, respectively. No significant differences were observed in baseline characteristics between the two groups. At 1 year follow‐up, patients in the ivabradine group had significantly lower heart rates (77.6 ± 14.7 vs. 81.1 ± 16.3 bpm; P = 0.005) and lower HF severity symptoms (New York Heart Association Functional class, 2.1 ± 0.7 vs. 2.3 ± 0.9; P < 0.001) than those from the non‐ivabradine group. Ivabradine users had significantly lower risks of 1 year cardiovascular mortality (5.8 vs. 12.2 per 100‐person year; P = 0.003), all‐cause mortality (7.2 vs. 14.0 per 100‐person year; P = 0.003), and total HF rehospitalization (42.3 vs. 72.6 per 100‐person year; P < 0.001) than non‐ivabradine users. Following multivariate analysis, the predischarge prescription of ivabradine remained independently associated with lower 1 year all‐cause mortality (hazard ratio, 0.45; 95% confidence interval, 0.28–0.74; P = 0.002) and cardiovascular mortality (hazard ratio, 0.41; 95% confidence interval, 0.24–0.72; P = 0.002). Conclusions The current study findings suggest that ivabradine treatment is associated with reduced risks of cardiovascular mortality, all‐cause mortality, and HF rehospitalization within 1 year among patients with acute decompensated HFrEF in real‐world populations.https://doi.org/10.1002/ehf2.13536Heart failureHospitalizationIvabradineMortalityReal‐world |
| spellingShingle | Chia‐Te Liao Jin‐Long Huang Huai‐Wen Liang Fa‐Po Chung Ying‐Hsiang Lee Po‐Lin Lin Wei‐Ru Chiou Wen‐Yu Lin Chien‐Yi Hsu Hung‐Yu Chang The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients ESC Heart Failure Heart failure Hospitalization Ivabradine Mortality Real‐world |
| title | The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients |
| title_full | The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients |
| title_fullStr | The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients |
| title_full_unstemmed | The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients |
| title_short | The association between ivabradine and adverse cardiovascular events in acute decompensated HFrEF patients |
| title_sort | association between ivabradine and adverse cardiovascular events in acute decompensated hfref patients |
| topic | Heart failure Hospitalization Ivabradine Mortality Real‐world |
| url | https://doi.org/10.1002/ehf2.13536 |
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