{"id":5,"date":"2008-10-14T00:44:17","date_gmt":"2008-10-13T23:44:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=5"},"modified":"2015-11-12T13:09:05","modified_gmt":"2015-11-12T12:09:05","slug":"beautiful-%e2%80%93-no-go-for-go-slow","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2008\/10\/14\/beautiful-%e2%80%93-no-go-for-go-slow\/","title":{"rendered":"BEAUTIFUL \u2013 no go for go slow with ivabradine"},"content":{"rendered":"<p style=\"text-align: justify\">Ivabradine is a pure heart-rate lowering agent that is a specific inhibitor of the <em>If <\/em>current in the sino-atrial node; currently it is licenced for the treatment of angina.\u00a0 The BEAUTIFUL (morbidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricUlar dysfunction) trial aimed to determine if heart rate lowering with ivabradine could reduce cardiovascular death and mortality in patients with stable coronary artery disease and impaired systolic function (&lt;40%), as several studies have demonstrated that a high heart rate is an independent predictor of both cardiovascular and all-cause mortality.<!--more--><\/p>\n<p style=\"text-align: justify\">\n10,917 eligible patients were enrolled in a randomised, double-blind, placebo-controlled, parallel-group manner.\u00a0 5479 patients received 5mg ivabradine, with the intention of increasing to the target dose of 7.5mg twice a day, and 5438 received matched placebo in addition to their other cardiac medications.\u00a0 The primary endpoint was a composite of cardiovascular death, and admission to hospital for new onset or worsening heart failure.<br \/>\nMean heart rate at baseline was 71.6 (SD 9.9) beats per minute (bpm); over a median follow-up of 19 months ivabradine reduced heart rate by 6bpm (SE 0.2) at 12 months, corrected for placebo.\u00a0 Of note, 87% patients were concomitantly taking beta-blockers, but no safety concerns were noted.\u00a0 Ivabradine did not affect the primary composite endpoint (HR 1.00, p=0.94), and 1233 patients (22.5%) in the treatment group had serious events, compared to 1239 (22.8%) in the control group (p=0.17). Treatment did reduce the secondary endpoints of non-fatal myocardial infarction (HR 0.64, p=0.001) and coronary revascularisation (HR 0.70, p=0.016).<br \/>\nThus although the study failed to reach its primary outcome, the data acquired seems to demonstrate the safety of giving ivabradine, even in combination with a beta-blocker.\u00a0 Although a direct comparison between these two drugs would be useful, it would be hard to justify ethically; further knowledge on the role of ivabradine in a heart failure population will be gained from the forthcoming SHIFT trial (Systolic Heart failure treatment with the If-inhibitor ivabradine Trial).<br \/>\n<strong>\u2022\u00a0\u00a0\u00a0 Fox K, Ford I, Steg PG, et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 2008; DOI:10.1016\/S0140-6736(08)61170-8. Available at: http:\/\/www.thelancet.com.<br \/>\n\u2022\u00a0\u00a0\u00a0 Reil JC, B\u00f6hm M. BEAUTIFUL results-the slower, the better? Lancet 2008; DOI:10.1016\/S0140-6736(08)61172-1. Available at: http:\/\/www.thelancet.com.<\/strong><\/p>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ivabradine is a pure heart-rate lowering agent that is a specific inhibitor of the If current in the sino-atrial node; currently it is licenced for the treatment of angina.\u00a0 The BEAUTIFUL (morbidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricUlar dysfunction) trial aimed to determine if heart rate lowering with [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2008\/10\/14\/beautiful-%e2%80%93-no-go-for-go-slow\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":47,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[279],"tags":[2955,406,405],"class_list":["post-5","post","type-post","status-publish","format-standard","hentry","category-general-cardiology","tag-heart-failure","tag-heart-rate","tag-ivabradine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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