Tag Archives: ivabradine

Case history A 79-year-old woman with a background history of non-ischaemic dilated cardiomyopathy with severe left ventricular (LV) impairment, left-bundle branch block (LBBB) with QRS duration 130–140 ms and LV dyssynchrony, underwent cardiac resynchronisation device implantation after optimisation of her heart failure medication. She continued to remain breathless (New York Heart Association [NYHA] grade III) even after implantation of the device. Device interrogation revealed only 50% pacing due to interference by predominantly unifocal ventricular ectopics (VEs) with VE load of 20% on 24-hour Holter monitoring (figure 1), which did not

New editorial board member Dr Ketan Dhatariya We are delighted to welcome Dr Ketan Dhatariya to our editorial board. Dr Dhatariya is a consultant in diabetes, endocrinology and general medicine at Norfolk and Norwich University Hospital, Norwich. He is also a senior lecturer at the University of East Anglia, and an assistant professor of medicine at St George’s University, Grenada, in the West Indies. He has published on a wide variety of diabetes- and endocrine-related subjects, including diabetes-related foot disease. He serves as meetings secretary for the Association of British Clinical Diabetologists, and medical secretary for the Spec

Introduction Stable angina is the most common manifestation of coronary heart disease. While considered relatively benign in terms of prognosis, the condition confers a higher risk of cardiovascular events than in the general population, with average annual mortality rates of 1–2%. Guidelines for the management of stable angina are relatively conservative in their approach, given their process of development. Moreover, stable angina management has not been as rigorously evaluated in large randomised trials as other coronary conditions. The role of newer treatment options in management algorithms also merits wider consideration. This expert

The licence follows the results of the SHIfT trial, involving more than 6,000 people, which demonstrated that patients with chronic systolic heart failure and a heart rate over 70 bpm had an 18% reduction (ARR = 4.2% p<0.0001) in the composite primary end point of cardiovascular death and hospitalisation due to heart failure. Ivabradine selectively lowers heart rate and the study showed benefits were greater in patients with higher heart rates (>75 bpm). Within the indication, Servier says ivabradine reduced the risk of death from heart failure by 39% (ARR 2.2% p=0.0006), the risk of death from all types of cardiovascular disease by 17%

Introduction Beta-adrenoceptor blocking drugs (beta blockers) are an established prognostic therapy for chronic heart failure (HF).1-4 Of the many proposed mechanisms mediating these favourable effects, that of heart rate (HR) control is gaining interest. The Systolic Heart Failure Treatment with Iƒ Inhibitor Ivabradine Trial (SHIFT) reported that ivabradine significantly reduced a combined end point of cardiovascular death or HF hospitalisations in a relatively high-risk HF population with an elevated resting HR.5 HR control, therefore, appears to be both a modifiable risk factor and a disease modifying variable in patients with impaired l

The new guideline from the National Institute for Health and Clinical Excellence (NICE)1 covers adults who have been diagnosed with stable angina due to atherosclerotic disease, following on from clinical guideline 95,2 which advises on diagnosis of chest pain of recent onset. A key priority for implementation in the latest guidance is to ensure that people with stable angina receive balanced information and have the opportunity to discuss the benefits, limitations and risks of their treatment. Initial management of stable angina should be to offer optimal drug treatment, addressing both the angina itself and secondary prevention of cardiovas

Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. SHIFT: ivabradine shows benefit in heart failure

New editorial board member We are delighted to welcome Steve Parry to our editorial board. Steve is a Senior Lecturer at Newcastle University’s Institute for Ageing and Health and Consultant Physician in Acute Medicine and Geriatrics at Newcastle’s Royal Victoria Infirmary. His clinical and research interests lie in syncope and falls, with particular expertise in the cardiovascular causes of the latter. He has published widely on these problems, is Chair of the British Geriatrics Society Cardiovascular Section, co-author of the European Society of Cardiology 2009 Syncope Guidelines and a member of the national Chapter 8 (CHD National Serv

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Introduction An elevated heart rate may be a primary determinant of myocardial ischaemia by altering the balance of oxygen demand and coronary perfusion. Given that there is considerable evidence showing survival is inversely related to heart rate, lowering heart rate would be expected to be an important tool in the management of angina.1-3 Theoretically it may also be beneficial in the prevention of myocardial infarction as the haemodynamic stresses placed upon the myocardium by a high heart rate are associated with coronary plaque rupture.4 Approaches to lowering heart rate include the use of beta blockers and certain calcium channel blocke