Ivabradine approved by NICE for heart failure

28 November 2012

The National Institute for Health and Clinical Excellence has accepted ivabradine (Procoralan) for use in certain patients with chronic heart failure.

Chronic heart failure affects about 900,000 people in the UK and is often caused by coronary artery disease, for example following an acute MI | SCIENCE PHOTO LIBRARY

The sinus node I_f inhibitor is recommended as an option for prescribing on the NHS to patients:

with NHYA class II–IV stable chronic heart failure with systolic dysfunction and
who are in sinus rhythm with a heart rate ≥75 bpm and
who are also receiving standard therapy, including a beta-blocker, an ACE inhibitor and an aldosterone antagonist, or when a beta-blocker is contraindicated or not tolerated, and
who have a reduced left ventricular ejection fraction (LVEF) ≤35%.

May be managed in primary care following initiation

Patients should only be prescribed ivabradine following 4 weeks of optimised standard therapy and under the supervision of a heart failure specialist with access to a multidisciplinary team. Subsequent dose titration and monitoring can be managed either by the same specialist or by a GP with a special interest in heart failure or a heart failure specialist nurse.

Dose adjusted according to response and heart rate

Patients should be started on 5mg twice daily with morning and evening meals. The dose is then adjusted according to response and heart rate, within range 2.5–7.5mg twice daily.

NICE guidance on ivabradine in heart failure

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