Effect of Ivabradine in Lowering Heart Rate and Quality of Life in Chronic Heart Failure Patients

Study Overview
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Brief Summary
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Elevated Heart rate (HR) (≥ 70 bpm) is one of the contributing factors in increasing the burden of hospitalization among Heart Failure patient. Ivabradine is a novel, selective and specific in inhibiting a Funny current in sinoatrial node Node and approved as an alternative therapy for Chronic Heart Failure (CHF) patients. CHF patients when treated with Ivabradine reported 39%, and 30% reduction in mortality and hospitalization rate respectively. Patient were treated with Ivabradine 5mg twice daily to determine its effect in lowering Heart rate and the Quality of Life (QOL) in Chronic Heart Failure patients

Detailed Description
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A prospective, post-marketing observational study was conducted in 50 chronic heart failure patients with age 30-70yrs of NYHA Class II and prescribed 5 mg Ivabradine twice daily. Heart rate was evaluated through ECG & quality of life was measured by a validated questionnaire EuroQol-5 Dimension 3 level version (EQ-5D-3L). Baseline demographic includes age, gender, height, weight, Body Mass Index, temperature, blood pressure and respiratory rate were recorded and patients were followed at week 4 and week 8. Safety and tolerability was assessed by adverse drug reaction (ADR) monitoring. Results were analyzed by statistical software SPSS version 20.0.

Official Title
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A Post-Marketing, Prospective, Observational Program: Effect of Ivabradrine in Lowering Heart Rate and Quality of Life in Chronic Heart Failure Patients

Conditions
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Chronic Heart Failure

Intervention / Treatment
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* Drug: Ivabradine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Written informed consent Known case of Chronic Heart Failure (New York Heart Association (NYHA) functional class II to III) Clinically stability (at least for 4 weeks) Resting heart rate of more than 70 beats/ min (bpm) as assessed from the 12-lead electrocardiogram. Exclusion Criteria: Hypersensitivity to the active substance or to any of the excipients Resting heart rate below 70 beats per minute prior to treatment Cardiogenic shock Acute myocardial infarction Severe hypotension (< 90/50 mmHg) Severe hepatic insufficiency Sick sinus syndrome Sino-atrial block Unstable or acute heart failure Pacemaker dependent (heart rate imposed exclusively by the pacemaker) Unstable angina Atrioventricular Block of 3rd degree The combination with a strong cytochrome P450 3A4 inhibitors such as azole antifungals (ketoconazole, itraconazole), macrolide antibiotics (clarithromycin, erythromycin, telithromycin), HIV protease inhibitors (nelfinavir, ritonavir) and nefazodone The combination with verapamil or diltiazem which are moderate CYP3A4 inhibitors with heart rate reducing properties. Pregnancy, lactation and women of child-bearing potential not using appropriate contraceptive measures

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Ivabradine|A prospective, post-marketing observational study was conducted in National Institute of cardiovascular disease, Karachi-Pakistan. Total 50 patients were advised to take 5 mg Ivabradine (SIVAB) twice daily for 8 weeks.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean difference of Heart Rate | The primary end-point was the overall response rate of patients to Ivabradine in achieving HR <70 Bpm | at 4 week and 8 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of problems reported in EQ-5D descriptive system | Quality of Life was determined through validated questionnaire EQ-5D-3L. It also assesses five dimensions of HR quality of life (HRQoL): mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Each dimension is measured one to three levels i.e 1, 2, 3. Where level 2 & 3 indicates 'problem' and level 1 denotes to 'no problem'. | at 4 week and 8 week | 
| Median score of EQ-5D visual analogue scale | The EQ-5D registers the self-rated health status of the respondent on the vertically visual analogue scale (EQ-5D VAS) from 0 to 100 where 100 indicates 'Best imaginable health' and 0 is said to be a 'Worst imagine health state'. | at 4 week and 8 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ivabradine, Heart Rate, Health Related Quality of Life, Safety, Chronic Heart Failure Patient