Ivabradine for Adults with Stable Chronic Heart Failure: A Review of Clinical Effectiveness [Internet]

Excerpt

Heart failure has been defined as “a complex clinical syndrome in which abnormal heart function results in, or increases the subsequent risk of, clinical symptoms and signs of reduced cardiac output and/or pulmonary or systemic congestion at rest or with stress. […] Chronic heart failure (CHF) is the preferred term representing the persistent and progressive nature of the disease.” Stable CHF is difficult to define, given that patients frequently deteriorate and are at risk of acute events.

There are over 660,000 people living with heart failure in Canada and over 90,000 new cases diagnosed every year in Canada according to 2012/13 data. Both decreasing left ventricular ejection fraction (LVEF) and functional capacity (as characterized by the New York Heart Association (NYHA) Functional Classification) have been associated with higher mortality.^,

Ivabradine was approved by Health Canada in 2017 for the treatment of chronic heart failure (CHF) for patients with an ejection fraction of less than or equal to 35%, heart rate of 77 or greater, and NYHA classification II or III. Guidelines have endorsed ivabradine for treatment of patients with CHF and LVEF of less than or equal to 35%.^, One large trial used and supported the 35% threshold.

Recently published guidelines suggested use of ivabradine in patients with ejection fractions of less than or equal to 40%.^, To inform decision making about use of ivabradine in an expanded population, a review was conducted to assess the current literature.

The CADTH Common Drug Review Report for Lancora (ivabradine) assessed the evidence for the use of ivabradine in patients with LVEF of <35%. This review (Rapid Response Summary with Critical Appraisal) is an upgrade to a CADTH Rapid Response Summary of Abstracts, which assessed the clinical effectiveness of ivabradine for adults with stable CHF and LVEF >35% and ≤40%. This report expands on the Summary of Abstracts by reviewing and assessing full text articles.