Heart Failure Ivabradine — RACP Adult Medicine MCQ

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ModerateCardiologyHeart Failure IvabradineRACP Adult Medicine

A 72-year-old man with HFrEF (LVEF 25%) on sacubitril/valsartan, bisoprolol, and eplerenone has a heart rate of 82 bpm in sinus rhythm. His beta-blocker is at maximum tolerated dose. According to the Australian heart failure consensus, what additional agent may reduce hospitalisation?

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Correct answer: B — Ivabradine

Ivabradine selectively inhibits the If current in the sinoatrial node, reducing heart rate without negative inotropic effects. It is indicated for HFrEF patients in sinus rhythm with HR ≥70 bpm despite maximum tolerated beta-blocker (or if beta-blocker contraindicated). The SHIFT trial showed a significant reduction in HF hospitalisation. It should NOT be used in AF.

Reference: NHF/CSANZ – 2022 – Heart Failure Consensus Statement; eTG – 2025 – Cardiovascular