Ivabradine in Heart Failure

This guidance is about using ivabradine in heart failure. It will only be started by specialist nurses, cardiologists, or GPSIs, but we will be responsible for continuing it, so it is worth knowing when it should be used. It works by slowing the pulse.

Ivabradine is recommended as an option for people with heart failure if:

  • NYHA II to IV, if they are stable, with systolic dysfunction
  • Sinus rhythm with rate 75bpm or more
  • They are used in combination with other drugs (b-blockers, ACEi, aldosterone antagonists) or when b-blockers are contraindicated or not tolerated.
  • Left Ventricular Ejection Fraction 35% or less

Ivabradine should only be started under the following conditions:

  • After 4/52 stabilisation period on other medications
  • It is started by Heart Failure nurse or specialist (GP can continue)

It is important to note that Ivabradine offers little benefit if patients are already on optimal b-blocker treatment, or are taking 50% or more of the optimal dose, so its main use is when b-blocker treatment can not be titrated up (eg because of hypotension).

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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