Contributor: Mat Bull

Less is more when it comes to heart rate in HF. Ivabradine, a sinus node inhibitor, lowers heart rate, thereby decreasing myocardial demand. Some beta blockers have mortality benefit in HFrEF as shown by the MERIT-HF and COPERNICUS trials, and a side effect of these drugs is heart rate lowering. Thus, beta-blockers are standard of care in HFrEF; however, at maximally indicated doses, undesired side effects often occur. Since ivabradine targets very specific ion channels within the SA node, further heart rate reduction is possible. But which patients are eligible for this therapy? Read on.