Vol. 4, Issue 1, Part A (2022)

Heart failure is one of the leading causes of hospitalizations and mortality worldwide, and its risk is increased with presence of angina. Major challenges faced are increased heart rate and other cardiovascular risks, timely diagnosis, presence of comorbidities, monetary burden, and polypharmacotherapy. This consensus was developed from the outcome of 6 online advisory board meetings conducted in September 2020 involving 80 cardiologists across India to simplify management of heart failure and stable angina by providing alternate pharmacotherapy approach using ivabradine. Various studies have accessed the efficacy and safety profile of ivabradine in management of heart failure and angina. The Proficient (Prolonged Release Formulation of Ivabradine once-daily in heart Rate Management) study showed that once daily Ivabradine prolonged release (PR) was equally safe as ivabradine twice daily instant release (IR) in heart failure. The Beautiful, Shift, and Signify trials have shown reduction in heart rate in heart failure and stable angina, with improvement in cardiovascular outcomes. The expert panel recommended to use ivabradine if target blood Pressure is not achieved and is more than 90 mm Hg. Drug interaction of ivabradine and itraconazole, diltiazem, or verapamil needs to be ascertained while prescribing these medications. Further, the experts recommend use of ivabradine when electrocardiogram shows atrial fibrillation and suggest that time of taking ivabradine should be advised considering the circardian rhythm and sympathetic drive and depending on use of single daily dose of ivabradine prolonged release instead of twice daily dose of ivabradine immediate release.