Ivabradine (Procorolan) for Heart Failure

The National Institute for Health and Clinical Excellence (NICE) is issuing final draft guidance recommending ivabradine (Procoralan) as a treatment option for some people with chronic heart failure.

Treatment for heart failure is designed to help improve life expectancy, quality of life and to avoid hospital admissions. We feel this decision is long overdue and is great news for some patients.

Ivabradine evidence

The heart-rate-lowering drug ivabradine significantly reduced the risk of cardiovascular death and hospital admissions for worsening heart failure when added to standard treatment in patients, according to a UK, US and European study in 2010.

The ‘Systolic Heart Failure treatment with the ivabradine Trial’, known as SHIFT, looked at whether lowering heart rate with ivabradine reduces cardiovascular death and admission to hospital.

The patients studied had worsening heart failure, chronic heart failure, systolic dysfunction and a high heart rate over 70 beats per minute (bpm) or higher.

6,505 patients from 37 countries were studied over around 23 months. Around half were randomly given ivabradine twice daily in addition to standard heart failure treatments. The other half had a dummy placebo treatment added instead.

Treatment with ivabradine significantly reduced the risk of major heart failure by 18% compared to the dummy treatment. 16% of patients taking ivabradine were admitted to hospital with worsening heart failure compared to 21% in the placebo group. 3% of patients in the group taking ivabradine died from heart failure compared to 5% taking the placebo.

Ivabradine brought about an average reduction in heart rate of 15 bpm.

Who would get the new treatment?

The new guidance covers ivabradine for people with classes of chronic heart failure called NYHA class II to IV and other restrictions. The new guidance says ivabradine is cost effective when used in combination with standard therapy, including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blockers are not appropriate.

The decision to use ivabradine would be taken by a heart failure specialist. The treatment would cost the NHS around £42 per patient a month.

For this cost compared to a hospital admission makes economic sense. Be aware if you have AF then ivabradine will not be prescribed.

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