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The Role of Ivabradine and Trimetazidine in the New ESC HF Guidelines.

ABSTRACT: The prevalence of heart failure (HF) is increasing, representing a major cause of death and disability, and a growing financial burden on healthcare systems. Despite the use of effective treatments with both drugs and devices, mortality remains high. There is therefore a need for new and effective therapeutic agents. Ivabradine is a specific sinus node inhibiting agent that was approved in 2005 by the European Medicines Agency, alone or in combination with a beta-blocker. Trimetazidine is a cytoprotective, anti-ischaemic agent established in the treatment of angina pectoris. In the 2012 European Society of Cardiology (ESC) guidelines for diagnosis and treatment of HF, ivabradine was recommended in symptomatic HF patients who are in sinus rhythm with left ventricular ejection fraction ≤35 % and heart rate higher than 70 beats per minute, despite optimal medical therapy, including maximally tolerated dose of beta-blocker. The role of trimetazidine in this setting was not mentioned. In the 2016 ESC guidelines, recommendations for ivabradine are unchanged but trimetazidine is included for the treatment of angina pectoris with HF. This article discusses the need for new therapeutic options in HF and reviews clinical evidence in support of these two therapeutic options.

SUBMITTER: Milinkovic I

PROVIDER: S-EPMC5490945 | biostudies-other | 2016 Nov

REPOSITORIES: biostudies-other

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Current Drug Therapy in Chronic Heart Failure: the New Guidelines of the European Society of Cardiology (ESC).

Project description:Congestive heart failure (HF) is a morbidity that is increasing worldwide due to the aging population and improvement in (acute) care for patients with cardiovascular diseases. The prognosis for patients with HF is very poor without treatment. Furthermore, (repeated) hospitalizations for cardiac decompensation cause an increasing economic burden. Modern drugs and the consequent implementation of therapeutic recommendations have substantially improved the morbidity and mortality of HF patients. This paper provides an overview of the current pharmacological management of HF patients, based on the 2016 guidelines of the European Society of Cardiology (ESC).

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The scale of scientific evidence behind the current ESC clinical guidelines.

Project description:BackgroundEuropean Society of Cardiology (ESC) clinical practice guidelines are currently considered as an essential tool supporting many cardiologists in clinical decision-making not only in Europe but all-over the world. In this study we analyzed these recommendations regarding their class of recommendations (COR) and level of evidence (LOE) to detect how solid is the scientific background behind these recommendations.MethodsWe have abstracted all the current guidelines defined as "the guidelines available on the ESC website by 01 October 2022". All recommendations were classified according to their COR (Class I, IIa, IIb, or III) and LOE (A, B, or C). As every topic has different number of recommendations, we have used the median values in comparisons between different topics to give all the topics the same weight.ResultsCurrent ESC guidelines consist of 37 clinical topics including a total of 4289 recommendations. Their distribution was 2140 with a median of 49.9% in Class I, Class II and Class III were 1825 with a median of 42.6% and 324 with a median of 7.5% respectively. LOE A was only present in 667(15.5%) recommendations, 1285(30%) in LOE B, while LOE C was behind the majority of the recommendations, 2337 with a median of 54.5%.ConclusionAlthough ESC guidelines are considered a gold standard for management of cardiovascular diseases, but surprisingly more than half of its recommendations are based on such scientific evidence. Deficiency in clinical trials is not the same across all guideline's topics, some are needier for clinical research.

| S-EPMC10105211 | biostudies-literature

Ivabradine and AF: Coincidence, Correlation or a New Treatment?

Project description:Ivabradine is a heart rate-lowering agent that inhibits pacemaker funny current (If). It has been approved by the European Medicines Agency and the US Food and Drug Administration for patients with stable angina and heart failure (HF). AF is a common issue especially in ischaemic heart disease and HF patients. In contrast to experimental findings and a limited number of clinical trials that demonstrate the emerging role of ivabradine for heart rate control in AF or maintenance of sinus rhythm, there is accumulating contradictory data indicating that there is, in fact, an increased incidence of new-onset AF among people who are taking ivabradine in clinical practice. This article reviews the most recent evidence highlighting the diversity of data in relation to the use of ivabradine and the onset of AF and whether it has a legitimate role in AF treatment and the maintenance of sinus rhythm.

| S-EPMC7358942 | biostudies-literature

Emerging role of ivabradine for rate control in atrial fibrillation.

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Ivabradine: Evidence and current role in cardiovascular diseases and other emerging indications.

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| S-EPMC6309574 | biostudies-literature

ACC/AHA guidelines superior to ESC/EAS guidelines for primary prevention with statins in non-diabetic Europeans: the Copenhagen General Population Study.

Project description:AimWe compared the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and the 2016 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on prevention of atherosclerotic cardiovascular disease (ASCVD) using different risk prediction models [US Pooled Cohort Equations (US-PCE for any ASCVD) and European Systematic COronary Risk Evaluation system (European-SCORE for fatal ASCVD)] and different statin eligibility criteria.Methods and resultsWe examined 44 889 individuals aged 40-75 recruited in 2003-09 in the Copenhagen General Population Study, all free of ASCVD, diabetes, and statin use at baseline. We detected 2217 any ASCVD events and 199 fatal ASCVD events through 2014. The predicted-to-observed event ratio was 1.2 using US-PCE for any ASCVD and 5.0 using European-SCORE for fatal ASCVD. The US-PCE, but not the European-SCORE, was well-calibrated around decision thresholds for statin therapy. For a Class I recommendation, 42% of individuals qualified for statins using the ACC/AHA guidelines vs. 6% with the ESC/EAS guidelines. Using ACC/AHA- vs. ESC/EAS-defined statin eligibility led to a substantial gain in sensitivity (+62% for any ASCVD and +76% for fatal ASCVD) with a smaller loss in specificity (-35% for any ASCVD and -36% for fatal ASCVD). Similar differences between the ACC/AHA and ESC/EAS guidelines were found for men and women separately, and for Class IIa recommendations. The sensitivity and specificity of a US-PCE risk of 5% were similar to those of a European-SCORE risk of 1.4%, whereas a US-PCE risk of 7.5% was similar to a European-SCORE risk of 2.4%.ConclusionsThe ACC/AHA guidelines were superior to the ESC/EAS guidelines for primary prevention of ASCVD, that is, for accurately assigning statin therapy to those who would benefit.

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From guideline to daily practice: Implementation of ESC-guidelines considering multidisciplinary and non-pharmacological care in heart failure in three ESC member states, a case study.

Project description:IntroductionTo alleviate the burden of Heart Failure (HF), the European Society of cardiology developed guidelines (ESC-guidelines) to optimise HF-diagnosis and treatment. These guidelines state that optimal HF-care is organised in a multidisciplinary programme in which pharmacological and non-pharmacological treatment is offered. Research has proven that multidisciplinary programmes and effective self-care behaviour significantly reduce HF-mortality and (re)hospitalisation, yet little is known about implementation of these ESC-guidelines. Therefore, the INTERACT study investigated current HF-care processes and guideline adherence in three North-West European regions: Maastricht (the Netherlands), Aachen (Germany) and Noorder-Kempen (Belgium).MethodsA case-study approach was adopted to study local implementation of ESC-guidelines considering non-pharmacological- and multidisciplinary care. National guidelines and local protocols were collected and studied to investigate the level of agreement with and implementation of ESC-guidelines. A matrix was developed to analyse the content of national and local guidelines and protocols in terms of non-pharmacological and multidisciplinary care.ResultsAll national organisations promote ESC guidelines, and some developed additional national guidelines. In region A, B and C patients receive multidisciplinary care in hospital based HF-outpatient clinics. Moreover, region B and C patients benefit from either structural (region B) or project based (region C) integrated care, in which specialist- and primary care work together to provide seamless care for HF-patients. However, in region A this seamless integrated care remains to be implemented.ConclusionAlthough ESC-guidelines recommend clearly considering Multidisciplinary- and non-pharmacological care implementation may differ between regions.

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Disconcordance between ESC prevention guidelines and observed lipid profiles in patients with known coronary artery disease.

Project description:BackgroundWe aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time.MethodsWe retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n?=?500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70?mg/dl for 2012-2013 and 2015-2016) were evaluated.ResultsOverall, 1500 subjects (mean age: 68.4?±?11.2?years, 75.8% male) from 813 attending primary care physicians were included. Mean LDL-level was 98.0?±?35.7?mg/dl, whereas 34.1% reached LDL-targets according to guidelines as applied at each time-point. Reduction of LDL-goals in 2011 lead to an initial decrease in LDL from 98.3?±?33.4?mg/dl in 2009-2010 to 93.9?±?36.3?mg/dl in 2012-2013 (p?=?0.045). This effect was no longer present in 2015-2016 (101.6?±?36.6?mg/dl, p?=?0.17). The rate of patients meeting recommended LDL-targets decreased over time (2009-2010: 56.6%, 2012-2013: 25.4%, 2015-2016: 20.2%, p?<?0.0001 for trend). Likewise, the frequency of statin-intake decreased over time (93.6% in 2009-2010 to 83.7% in 2015-2016, p?<?0.0001). While use of medium intensity statins was most frequent (69.4%), only 20.9% of patients with medium intensity statins reached LDL-targets according to guidelines.ConclusionIn a large clinical cohort of patients with known coronary artery disease, reduction of LDL-targets in ESC-guidelines in 2011 led to an initial decline in LDL-levels, while this effect was attenuated over time with the majority of patients missing treatment goals. Higher acceptance and compliance of statin therapy is warranted to utilize its effect in secondary prevention in CAD-patients.

| S-EPMC6310742 | biostudies-literature

Noninvasive Diagnostic Approach to a Rare Variant of Takotsubo Syndrome: From ESC Guidelines to Real World.

Project description:Takotsubo syndrome is found in about 5%-6% of patients presenting with suspected ST-elevation myocardial infarction. Coronary angiography with left ventriculography is currently considered the modality of choice for the diagnosis. However, improvements of noninvasive diagnostic techniques have been allowing for definite assessment of ventricular function and anatomy. In this setting, the combined use of coronary computed tomography angiography and cardiac magnetic resonance may play a pivotal role for a complete noninvasive diagnosis and management of these patients. We present a case of a 52-year-old woman who presented to our department complaining chest pain and showing left ventricular systolic dysfunction, electrocardiography abnormalities, and mild elevation of cardiac-specific serum enzymes.

| S-EPMC8388316 | biostudies-literature

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