Summary

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• Corlanor (ivabradine) is indicated to reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with reduced left ventricular ejection fraction, and for the treatment of stable symptomatic heart failure due to dilated cardiomyopathy in pediatric patients ages 6 months and older.
• This summary is based on the review of 17 systematic review(s)/meta-analysis(es). ^[1-17]
• Ivabradine significantly reduces heart rate (pooled mean difference of -15.95) and improves left ventricular ejection fraction (LVEF) (mean difference of 3.93) in patients with HFrEF, while also reducing hospitalizations for heart failure or cardiovascular death.
• In patients with Dilated Cardiomyopathy (DCM), Ivabradine reduces heart rate and ventricular volume, and improves cardiac function, though it does not significantly affect prognosis.
• Combination therapy including Ivabradine with beta-blockers (BB) and angiotensin receptor-neprilysin inhibitors (ARNi) shows added benefits in heart rate reduction and LVEF improvement, but Ivabradine does not outperform these combinations in reducing mortality.
• Ivabradine does not significantly improve exercise capacity (measured by peak VO₂) or quality of life in patients with Heart Failure with Preserved Ejection Fraction (HFpEF), and shows no significant reduction in cardiovascular mortality compared to placebo.
• Ivabradine was associated with a comparable risk of total adverse events to background therapy, with notable adverse effects being visual disturbances (RR = 4.76) and asymptomatic bradycardia (RR = 3.78).
• There was no significant increase in cardiovascular mortality or overall adverse events when comparing Ivabradine to placebo.
• No specific increased safety concerns were identified for subgroups such as HFrEF with sinus rhythm and HR ≥ 70 bpm or those with chronic kidney disease, suggesting a consistent safety profile across these populations.
• Significant improvements in cardiac function, including LVEF, LVESV, and LVEDV, were observed in patients with HFrEF and sinus rhythm with HR ≥ 70 bpm, with no additional safety concerns; benefits were also noted in the CKD with HFrEF subgroup when Ivabradine was combined with SGLT2i and ARNi, maintaining a similar safety profile across subgroups.