Ivabradine for treating chronic heart failure

Ivabradine is recommended as an option for treating chronic heart failure for people:

• with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and

• who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and

• who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and

• with a left ventricular ejection fraction of 35% or less.

Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists.

Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse.