What are the use cases for Ivabradine (Corlanor) in clinical practice?

From the Guidelines

Ivabradine (Corlanor) should be considered in clinical practice for patients with heart failure with reduced ejection fraction (HFrEF) and a left ventricular ejection fraction (LVEF) ≤35%, who are in sinus rhythm with a resting heart rate of ≥70 bpm, despite being on stable guideline-directed medical therapy (GDMT) for at least 4 weeks, as evidenced by the 2022 AHA/ACC/HFSA guideline 1. The primary use case for ivabradine is in the management of heart failure, specifically for reducing hospitalization due to heart failure, as demonstrated in the SHIFT study 1.

• Key patient characteristics for ivabradine use include:
  • HFrEF with LVEF ≤35%
  • Sinus rhythm with a resting heart rate of ≥70 bpm
  • Stable GDMT for at least 4 weeks
  • Previous hospitalization for heart failure in the preceding 12 months
• It is crucial to note that ivabradine should only be considered after patients have been initiated and uptitrated to target doses of beta-blocker therapy, as tolerated, due to the well-proven mortality benefits of beta-blockers 1.
• The benefit of ivabradine results from a reduction in heart rate, and its use should be aimed at achieving a resting heart rate of 50-60 beats per minute, with careful monitoring for potential side effects such as bradycardia, atrial fibrillation, and visual disturbances.

From the FDA Drug Label

Ivabradine is a hyperpolarization-activated cyclic nucleotide-gated channel blocker indicated: • To reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with reduced left ventricular ejection fraction. Ivabradine tablets are a prescription medicine used: • to treat adults who have chronic (lasting a long time) heart failure, with symptoms, to reduce their risk of hospitalization for worsening heart failure.

The use cases for Ivabradine (Corlanor) in clinical practice are:

• Reduction of hospitalization risk: to reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with reduced left ventricular ejection fraction.
• Treatment of chronic heart failure: to treat adults who have chronic heart failure, with symptoms, to reduce their risk of hospitalization for worsening heart failure 2, 2.

From the Research

Use Cases for Ivabradine (Corlanor) in Clinical Practice

• Ivabradine is used in the treatment of adults with New York Heart Association class II-IV chronic heart failure with systolic dysfunction, in sinus rhythm, with a heart rate of ≥75 beats per minute (bpm) 3.
• It is recommended for patients with heart failure with reduced ejection fraction (HFrEF) who have a sinus rhythm and a heart rate of ≥70 bpm, despite receiving maximum tolerated beta-blocker therapy or when beta-blockers are contraindicated 4, 5, 6.
• Ivabradine can reduce the risk of heart failure mortality and hospitalization in HFrEF patients, and it also effectively reduces resting heart rate and improves left ventricular ejection fraction (LVEF) 4.
• The drug is associated with a greater risk of symptomatic and asymptomatic bradycardia, which is a common adverse effect 4, 3.
• Ivabradine therapy is also associated with improved left ventricular diastolic function, increased exercise tolerance, and improved quality of life in patients with heart failure 7.

Patient Eligibility

• Patients with HFrEF who are on effective beta-blocker therapy, up-titrated to effective/maximal tolerated dose, and have a heart rate of ≥70 bpm may be eligible for ivabradine treatment 5.
• Patients who are not on beta-blocker therapy due to intolerance or major contraindications may also be eligible for ivabradine treatment 5.
• The eligibility for ivabradine treatment in real-life clinical practice is around 17% in a carefully managed population of patients with moderate and stable HFrEF 5.

Clinical Benefits

• Ivabradine reduces the risk of heart failure mortality and hospitalization in HFrEF patients 4.
• It improves LVEF and reduces resting heart rate in HFrEF patients 4.
• Ivabradine therapy increases peak oxygen uptake during exercise and 6-min walk test in HFrEF patients, and improves quality of life 7.
• The drug has a significant effect on reducing the composite primary endpoint of cardiovascular death and hospitalizations for worsening heart failure in patients with HFrEF 6, 3.