Yuri M Lopatin1, Martin R Cowie2, Anna A Grebennikova3, Hamayak S Sisakian4, Zurab M Pagava5, Hamlet G Hayrapetyan6, Timur A Abdullaev7, Leonid G Voronkov8, Anna I Chesnikova9, Vira I Tseluyko10, Ekaterina I Tarlovskaya11, Gülnaz M Dadashova12, Salim F Berkinbaev13, Maria G Glezer14, Natalia A Koziolova15, Amina G Rakisheva13, Zviad V Kipiani16, Alena K Kurlyanskaya17. 1. Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation. Electronic address: ylopatin@volgmed.ru. 2. Imperial College London (Royal Brompton Hospital), Sydney Street, London SW3 6HP, United Kingdom. Electronic address: m.cowie@imperial.ac.uk. 3. Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation. 4. University State Hospital 1, Yerevan State Medical University, 2, Koryun Street, Yerevan 375025, Armenia. 5. Centre of Vascular and Heart Diseases, 5, Lubliana Street, Tbilisi, Georgia. 6. Yerevan State Medical University, 14, Titogradyan Street, Yerevan 0087, Armenia. 7. 4, Yunusabad Street Osiyo, Tashkent 100052, Uzbekistan. 8. National Scientific Center Strazhesko Institute of Cardiology, National Academy of Medical Sciences, 5, Narodnogo Opolchenia Street, Kyiv 03680, Ukraine. 9. Rostov State Medical University, 29, Nahichevansky Avenue, Rostov-on-Don 344022, Russian Federation. 10. Kharkiv Medical Academy of Postgraduate Education, 58, Korchahintsiv Street, Kharkiv 61176, Ukraine. 11. Nizhny Novgorod State Medical Academy, 10/1, Minin & Pozharsky Square, Nizhny Novgorod 603950, Russian Federation. 12. Scientific Research Institute of Cardiology, 316, Tbilisi Avenue, Baku, AZ1012, Azerbaijan. 13. Scientific Research Institute of Cardiology and Internal Diseases, 120, Aiteke Bi Street, Almaty 050000, Kazakhstan. 14. I.M. Sechenov First Moscow State Medical University, 2, Bolshaya Pirogovskaya Street, Moscow 119991, Russian Federation. 15. Perm State Medical Academy, 39, Petropavlovskaya v Street, Perm 614000, Russian Federation. 16. "New Hospital", 12, Krtsanisi Street, Tbilisi 0114, Georgia. 17. Republican Scientific and Practical Centre of Cardiology, 110B, R. Luxemburg Street, Minsk 220036, Belarus.
Abstract
BACKGROUND: Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. METHODS AND RESULTS: A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. RESULTS: At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. CONCLUSIONS: Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.
BACKGROUND: Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. METHODS AND RESULTS: A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. RESULTS: At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. CONCLUSIONS: Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.