Optimization of heart rate lowering therapy in hospitalized patients with heart failure: Insights from the Optimize Heart Failure Care Program

Background: Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate >= 70 bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. Methods and results: A retrospective analysis was performed on 370 hospitalized HF patients with heart rate >= 70 bpm (150 BB + ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. Results: At 1 month, 3 months, 6 months and 12 months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB + ivabradine vs BBs alone. At 12 months, all-cause mortality or HF hospitalization was significantly lower with BB + ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P < 0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12 months with BB + ivabradine vs BBs alone (P = 0.0001). With BB + ivabradine, significantly more patients achieved >= 50% target doses of BBs at 12 months than on admission (82.0% vs 66.6%, P = 0.0001), but the effect was non-significant with BBs alone. Conclusions: Heart rate lowering therapy with BB + ivabradine started in hospitalized HF patients (heart rate >= 70 bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12 months. A prospective randomized trial is needed to confirm the advantages of this strategy. (C) 2017 Elsevier B.V. All rights reserved.