Evaluating the role of ivabradine in acute decompensated heart failure: A systematic review and meta-analysis

被引:0
作者
Ashraf, Saad [1 ]
Khalaf, Abbas Kamil Sh. [2 ]
Fatima, Laveeza [3 ]
Hashim, Hashim Talib [4 ]
Irfan, Hamza [5 ]
Ashfaq, Haider [6 ]
Khan, Maryam Ahmed [7 ]
Zahid, Arhamah [7 ]
Akram, Umar [3 ]
Goyal, Aman [8 ,9 ]
机构
[1] Dow Univ Hlth Sci, Dept Internal Med, Karachi, Pakistan
[2] Al Nasiriyah Teaching Hosp, Dept Internal Med, Thi Qar, Iraq
[3] Allama Iqbal Med Coll, Dept Internal Med, Lahore, Pakistan
[4] Univ Warith Al Anbiyaa, Coll Med, Dept Internal Med, Karbala, Iraq
[5] Shaikh Khalifa Bin Zayed Al Nahyan Med & Dent Coll, Dept Internal Med, Lahore, Pakistan
[6] Allama Iqbal Med Coll, Dept Med, Lahore, Pakistan
[7] Fazaia Med Coll, Dept Internal Med, Islamabad, Pakistan
[8] Seth GS Med Coll, Dept Internal Med, Acharya Donde Marg, Mumbai 400012, India
[9] King Edward Mem Hosp, Acharya Donde Marg, Bombay 400012, India
关键词
Ivabradine; Acute decompensated heart failure; Heart rate; Systematic review; Meta-analysis; RATE REDUCTION; MANAGEMENT;
D O I
10.1016/j.cpcardiol.2024.102604
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Acute decompensated heart failure (ADHF) presents a significant global health challenge, with high morbidity, mortality, and healthcare costs. The current therapeutic options for ADHF are limited. Ivabradine, a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, has emerged as a potential therapy for ADHF by reducing the heart rate (HR) without negatively affecting myocardial contractility. However, the evidence regarding the efficacy and safety of ivabradine in patients with ADHF is limited and inconsistent. This meta-analysis aimed to evaluate the efficacy and safety of ivabradine for ADHF based on observational studies. Methods: A systematic literature search was conducted following PRISMA guidelines to identify relevant observational studies comparing ivabradine with placebo in adult patients with ADHF. Data were pooled using a random-effects model, and heterogeneity was assessed. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Results: Four observational studies comprising a total of 12034 patients. Meta-analysis revealed that ivabradine significantly reduced all-cause mortality (RR: 0.66, 95 % CI: 0.49-0.89, p < 0.01) and resting HR (MD:-12.54, 95 % CI:- 21.66-3.42, p < 0.01) compared to placebo. However, no significant differences were observed in cardiovascular mortality, hospital readmission for all causes, changes in LVEF, or changes in LVEDD. Sensitivity and publication bias assessments were conducted for each outcome. Conclusion: Ivabradine may be beneficial for reducing mortality and HR in patients with ADHF. However, its impact on other clinical outcomes such as cardiovascular mortality, hospital readmission, and cardiac function remains inconclusive. Further research, particularly well-designed RCTs with larger sample sizes and longer follow-up durations, are warranted.
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页数:8
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