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Ivabradine Eligibility in HFrEF — EECC MCQ

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EasyHeart FailureIvabradine Eligibility in HFrEFEECC

A 70-year-old man with HFrEF asks about the role of ivabradine. He is on bisoprolol 10 mg daily with a resting HR of 78 bpm, LVEF 30%, and sinus rhythm. Is he eligible for ivabradine?

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Correct answer: B — Yes — ivabradine is recommended (Class IIa) for symptomatic HFrEF patients in sinus rhythm with HR ≥70 bpm despite maximally tolerated beta-blocker dose; it selectively inhibits the If ('funny') current in the sinoatrial node, reducing HR without affecting contractility or BP

Yes. This patient has HFrEF with LVEF 30%, is in sinus rhythm, has a resting HR of 78 bpm, and is already on the maximum usual licensed dose of bisoprolol for HFrEF. Ivabradine is an add-on heart-rate-lowering treatment for symptomatic, stable HFrEF when sinus rhythm persists with an elevated resting HR despite maximally tolerated beta-blocker therapy; it does not replace beta-blockers. It is ineffective in AF because its action depends on the sinoatrial node. Mechanistically, it selectively inhibits the sinoatrial node If ('funny') current, reducing heart rate without negative inotropy and with little effect on blood pressure. In UK practice, NICE uses a threshold of HR ≥75 bpm for NHS use in chronic heart failure, which this patient also meets.

Reference: NICE Technology Appraisal TA267: Ivabradine for treating chronic heart failure, 2012 (current NICE guidance). https://www.nice.org.uk/guidance/ta267/chapter/1-Recommendations