Efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease

Background: Heart rate is the important key factor for determining the cardiac output, myocardial oxygen demand and coronary blood flow. Reduction in heart rate is the main stay of treatment for preventing and treating IHD. Due to the interactions with other drugs and adverse effects of the conventional drugs, the management of IHD focused on novel targets. Ivabradine is a novel specific and selective if current inhibitor of SA node. The objective of the study was to efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease. Methods: Interventional, open label, prospective clinical study was done over a period of 1 year. Single centered study conducted in 50 patients in the Outpatient Department of cardiology, Tirunelveli Medical College Hospital, Tirunelveli. Endpoints noted were reduction in resting heart rate using 12 lead ECG and improvement in Canadian cardiovascular society (CCS) class of angina grading. Results: Ivabradine in reducing the heart rate at the end of 1 month (86.60±9.16) and at the end of 3 months (81.82±8.37) compared with baseline (93.08±11.67). CCS class of grade of angina also improved at the end of one month and 3 months compared with baseline. Grade IV (3 - 0 - 0), grade III (7 - 3 - 1) and grade II (40 - 8 - 9). Conclusions: Ivabradine is safe and effective in preventing and treating further anginal attacks in patients with chronic stable ischemic heart disease already on atenolol therapy.