Heart rate reduction and cardiovascular outcomes: is there a therapeutic relation?

摘要

Recent data suggest benefit from heart rate (HR) reduction in in several heart conditions. The pure HR slowing If channel blocker, ivabradine (acting solely to slow spontaneous diastolic depolarization in the sino-atrial node) is approved (Europe) for preventing angina pectoris (as effectively as beta and calcium channel blockers) in patients (pts) with coronary artery disease (CAD). Also, in pts with chronic stable CAD and HR >70bpm, BEAUTIFUL data suggest ivabradine reduces fatal and non-fatal myocardial infarction and indications for revascularization (particularly in pts with angina); small clinical trials also suggest improved cardiac function and symptoms in patients with heart failure and systolic dysfunction. The SHIFT study now has defined the drug's efficacy for reducing cardiovascular deaths or hospitalizations by 18% on top of standard background therapy when pre-therapy HR is >70bpm.