Ivabradine use more consistent in HF patients with in-hospital recommendation
Initiating ivabradine before discharge among patients with stabilized HF increased ivabradine use at 180 days and lowered heart rates without reducing beta-blocker use or increasing adverse events, according to findings presented at the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
Robert John Mentz, MD, and colleagues sought to address predischarge ivabradine (Corlanor, Amgen) initiation in stabilized patients with acute HF.
“The hospitalization rate in heart failure patients is quite high despite a number of good therapies, yet we have ivabradine, a relatively new therapy that can reduce hospitalization, and we still aren’t using it to the extent possible,” Mentz, an associate professor of cardiology at Duke University Medical Center, said in a press release.
Mentz and colleagues analyzed data from PRIME-HF, an investigator-initiated, randomized, open-labeled study of predischarge initiation of ivabradine vs. usual care.
Eligible patients were hospitalized for acute HF with reduced ejection fraction, in sinus rhythm with a heart rate of at least 70 bpm, the researchers wrote. Primary endpoint was the proportion of patients on ivabradine at 180 days.
Mentz and colleagues stratified 104 patients (mean age, 57 years; 36% women; 64% black). At 180 days, 40.4% of patients with predischarge initiation were treated with ivabradine compared with 11.5% of usual care patients (OR = 5.19; 95% CI, 1.88-14.33).
The predischarge initiation group experienced greater reduction in heart rate through 180 days compared with the usual-care group (median, –10 bpm; 95% CI, –15.7 to –4.3 vs. 0.7 bpm; 95% CI, –5.4 to 6.7), the researchers wrote.
“This was a small study, but it provides important evidence of the safety and efficacy of starting this medication in the hospital period,” Mentz said in the release. “There’s often a tendency to just say, ‘Let’s wait until we see the patient back in the clinic in a couple of weeks after hospital discharge.’ But the reality is that so often things are incredibly busy in the outpatient setting and many patients never get started on the right medications if we delay. Our message is to act now and help patients get the greatest benefits as early as possible.” – by Earl Holland Jr.
Mentz RJ, et al. Poster No. 252. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Disclosures: Mentz reports receiving a research grant and honoraria from Amgen. Please see the study for all other authors’ relevant financial disclosures.