Early Use of Ivabradine in Heart Failure (Ivabradine)
Heart Failure With Reduced Ejection Fraction, Decompensated Heart Failure
About this trial
This is an interventional treatment trial for Heart Failure With Reduced Ejection Fraction focused on measuring Decompensated Heart Failure, Ivabradine, ST2 Biomarker
Eligibility Criteria
Inclusion Criteria:
- Patient with acute heart failure either newly diagnosed or decompensated heart failure after stabilization
- Patients > 18 years old
- Left ventricular ejection fraction less than 40 % of presumed irreversible etiology
- Clinically stable 24-48 hours after admission
- Sinus rhythm with heart rate above 70 bpm
- No previous treatment with ivabradine
Exclusion Criteria:
- Patients less than 18 years.
- Arterial fibrillation before inclusion.
- Ventricular dysfunction due to acute event (Myocarditis, AMI). 4- cardiogenic shock
5. Patients are taking drug interact with ivabradine. 6- carrier or candidate for pacemaker, heart transportation, cardiac surgery or other cardiovascular procedure
Sites / Locations
- El Demerdash Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Ivabradine group
Control group
an initial dose of 5 mg/12 hours of Ivabradine will be added to beta-blockers (bisoprolol 2.5 mg/day) and ivabradine will be increased until a dose of 7.5 mg/12 hours according to HR. The heart rate target will be at least <70 bpm and not lower than 60 bpm. If HR decreases below 60 bpm, ivabradine and/or beta-blockers doses will be decreased to the previous dose. After discharge, beta-blockers up-titration will be continued during follow-up visit.
beta-blocker (bisoprolol 2.5 mg/day) and it will be doubled every 2 weeks during the admission according to the stability of HR, blood pressure and tolerability of patients. Ivabradine will be only added after reaching bisoprolol optimal dose (10mg) or maximum tolerated dose and the HR is still above 70 bpm. If HR decreases below 60 bpm, ivabradine dose will be decreased.