Summary

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• This summary is based on the review of 14 systematic review(s)/meta-analysis(es). ^[1-14]
• Effectiveness in Dilated Cardiomyopathy (DCM) with Congestive Heart Failure: Ivabradine significantly reduced resting heart rate (mean difference (MD) = -15.95, 95% confidence interval (CI) [-19.97, -11.92]), improved left ventricular ejection fraction (LVEF), and reduced left ventricular end-systolic diameter (MD = -5.90, 95% CI [-9.36, -2.44]). It also improved quality of life (QoL) and New York Heart Association (NYHA) class without significantly affecting prognosis.
• Heart Failure with Reduced Ejection Fraction (HFrEF): Ivabradine demonstrated effectiveness in reducing hospitalization for heart failure or cardiovascular death, improving ejection fraction, and enhancing health-related QoL with a similar risk of adverse events compared to background therapy alone.
• Acute Coronary Syndrome (ACS): Ivabradine effectively controlled heart rate and improved left ventricular function in patients with ACS, though it did not significantly reduce short-term mortality.
• Chronic Kidney Disease (CKD) Subgroup: In patients with CKD, ivabradine reduced the risk of cardiovascular death or hospitalization for heart failure compared to neurohormonal inhibition (hazard ratio (HR) 0.82, 95% credible interval (CrI) [0.69-0.98]), indicating benefit in this subgroup.
• Increased Risk of Specific Adverse Events: Ivabradine was associated with an elevated risk of atrial fibrillation (relative risk (RR) = 1.19, 95% CI [1.04, 1.35]), bradycardia (RR = 3.95, 95% CI [1.88, 8.29]), and visual disturbances (RR = 4.76, 95% CI [3.03, 7.48]). Additionally, it showed a slight increase in non-serious adverse events (RR = 1.13, 95% CI [1.11, 1.16]).
• Safety in Specific Populations: In patients with CKD, ivabradine demonstrated a safety profile comparable to neurohormonal inhibition, and in heart failure (HF) and ACS patients, ivabradine did not significantly impact the risk of major adverse cardiovascular events (MACE) or overall mortality.
• Ivabradine demonstrated varied effectiveness across specific populations: it showed significant benefits in HFrEF and in patients with CKD by reducing cardiovascular death or hospitalization risk (HR 0.82, 95% CrI [0.69-0.98]), while benefits in heart failure with preserved ejection fraction (HFpEF) were less pronounced. In patients with ACS, ivabradine improved heart rate control and left ventricular function but did not significantly impact short-term mortality, and no significant quality of life improvements were observed in angina pectoris due to coronary artery disease (CAD).