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Ivabradine in HFrEF — RACP Adult Medicine MCQ

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ModerateCardiologyIvabradine in HFrEFRACP Adult Medicine

A 60-year-old man with HFrEF (LVEF 25%) on quadruple therapy (sacubitril/valsartan, carvedilol, eplerenone, dapagliflozin) has NYHA III symptoms despite optimal doses. HR is 78 bpm in sinus rhythm. BP is 105/65 mmHg. QRS is 100 ms (narrow). What is the most appropriate additional therapy?

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Correct answer: A — Ivabradine

Ivabradine reduces heart rate by selectively inhibiting the If (funny) channel in the SA node. It is indicated for HFrEF with LVEF ≤35%, sinus rhythm, HR ≥70 bpm on maximally tolerated beta-blocker (SHIFT trial). This patient's HR is 78 on carvedilol — meets criteria. Ivabradine reduces HF hospitalisation. It cannot be used in AF.

Reference: NHFA/CSANZ – 2023 – Heart Failure; SHIFT Trial