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Ivabradine Improves Outcomes in Some Heart Patients

Higher resting heart rate independently linked with increased mortality

MONDAY, Sept. 1 (HealthDay News) -- Use of ivabradine, a heart-rate lowering drug, may improve outcomes in patients with coronary artery disease and a high heart rate, according to a study published online Aug. 31 in The Lancet and also presented at the European Society of Cardiology Meeting held Aug. 30 to Sept. 3 in Munich, Germany. A second study indicates that a higher resting heart rate in patients with heart disease is a strong, independent risk factor for death.

In the BEAUTIFUL study, Kim Fox, M.D., from Royal Brompton Hospital in London, United Kingdom, and colleagues randomly assigned 10,917 patients with stable coronary artery disease and left-ventricular systolic dysfunction to ivabradine or placebo in addition to any prescribed cardiovascular medication. The researchers found that ivabradine had no effect on the composite outcome of cardiovascular death or hospitalization for acute myocardial infarction or heart failure in the whole population or in patients with a heart rate of 70 beats per minute (bpm) or greater. However, treatment did significantly reduce hospitalization for fatal or non-fatal myocardial infarction (hazard ratio 0.64) and coronary revascularization (hazard ratio 0.70).

In the second article, a sub-group analysis was performed of the BEAUTIFUL study's placebo group, in order to determine if higher resting heart rate was a marker for cardiovascular disease and death. The researchers found that patients with heart rates above 70 bpm group had higher incidence of cardiovascular death, admission to hospital for heart failure, admission to hospital for heart attack and coronary revascularization.

"The BEAUTIFUL study has valuable lessons for clinical practice and illustrates the importance of individual decision-making," write the authors of an accompanying editorial. "It remains to be seen whether or not the concept of the slower the better holds true."

Servier provided funding for the studies; the authors have disclosed financial relationships with Servier.

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