Although it has been demonstrated that ivabradine can improve clinical outcomes in patients with chronic heart failure, the typical formulation has the drawback of a limited duration of action, necessitating twice daily administration. Researchers from the FIRST study (published this week in JACC) evaluated the role of ivabradine hemisulfate sustained release (SR), a novel long-acting formulation that requires only one daily administration. They found that ivabradine SR, in addition to the best standard therapy, improves heart function in patients with HFrEF. Thus, the new regimen helps to streamline the heart failure “polytherapy” regimens presently recommended everywhere and may even increase adherence.
The most effective care for heart failure (HF) depends on patient adherence to the medical therapy prescribed by guidelines, and drug dose frequency has a significant impact on compliance. According to estimates, barely 50% or less chronically sick individuals take their meds as directed. Therefore, the current aim is to simplify HF treatment without sacrificing effectiveness.
Patients with stable HFrEF in NYHA functional classes II-IV were included in the current trial and randomized to receive ivabradine SR or a placebo in addition to their usual medicines. The change in left ventricular (LV) end-systolic volume index between baseline and week 32 served as the main outcome.
In terms of the primary endpoint, both arms showed a considerably higher improvement in the left ventricular end-systolic volume index (LVESVI) after 32 weeks of follow-up, with ivabradine SR having the most impact.
In the Kansas City Cardiomyopathy Questionnaire overall, the left ventricular end-diastolic volume index, the LVEF, resting heart rate, and HF hospitalization/cardiovascular illness all showed greater improvement with ivabradine SR medication.
The N-terminal pro-B-type natriuretic peptide levels of more patients in the ivabradine SR group were reduced by at least 30%. Both the 6-minute walk test and all-cause mortality did not vary from each other. In actuality, the experiment demonstrated that ivabradine-HF therapy may be administered more simply without losing effectiveness.
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