CURRENT PERSPECTIVES FROM THE 2020 VIRTUAL INTERNATIONAL HEART FAILURE SUMMIT FOR THERAPEUTIC HEART RATE REDUCTION WITH CARVEDILOL AND IVABRADINE IN THE FOREFRONT. (April 2021)

• Record Type: Journal Article
• Authors: Bansal, Sandeep; Chaurasia, Ajay; Rao, Nageshwara; Aravindakumar, S.; Dasbiswas, Arup; Malhotra, Ashish; Khera, Ashok; Kumbala, Dayanand; Trivedi, Ak; Sinha, Ajay
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000747696.07231.0f
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Disseminate the contemporary global evidences and practices among experts for management of management of (reduced) HFrEF, (mid-range) HFmrEF/ (recovered) HFrecEF and the role of Carvedilol and Ivabradine in the forefront through live webinar Design and method: A virtual learning collaborative educational initiative was convened on September 27, 2020 by Prof Michael Bohm live from Germany with high expertise rank within 0.02% of 158, 672 published authors worldwide on heart failure in last one decade, with 1853 continuous active participants at forefront of HF management across India. The first module focused on need to target Ejection Fraction (EF) as a measure for improvement in outcomes in HF and second for evidence for the novel combination approach to utilise beta blockers with Ivabradine to improvise the outcomes in HF Results: Analysis of ESC HF long term registry represents diverse phenotypes of demography, clinical presentation, aetiology with continuum in HFmrEF and HFrEF. Elevated HR in failing heart is a maladaptation which when lowered to 55 to 65 beats per minute (bpm), with beta blockers, helps improve myocardial oxygen demand and coronary perfusion time with independent effects on heart failure. Therapeutic heart rate reduction is strongly correlated with reduced mortality and HR reduction of 5 bpm using beta blockers provide 14% risk reduction in mortality. Ivabradine mechanistically enables unloading of heart by facilitating the acceptance of higher doses of carvedilol as the drop in HR in tolerated better by conserving energy during systolic phase and improves contractility during diastolic phase. Pharmacokinetic properties of extended release formulation through logical technological innovation enhances the release of Ivabradine which mitigates the levels to fall below the critical levels. Secondary analysis of large trials show that combination works efficiently, and this is substantiated by the 2016 ESC guidelines for acute and chronic HF, which suggests higher level of evidence for the rationale Conclusions: Ivabradine improves uptitration of beta blockers in HF. Distinctive pharmacological properties of Carvedilol for unloading the heart makes it an evidence-based choice for the combination with Ivabradine, which antagonises spontaneous depolarisation for effective therapeutic heart rate reduction for managing heart failure.