The presentation addresses important questions around improving survival in HF patients. Each question is contemplated in different aspects:

• Is it a good idea to reduce HR?
  • Heart rate reduction by 10 beats saves about 5KG ATP per day; heart rate is closely associated with life expectation
  • Identification of heart rate associated loci and their effects on cardiac conduction and rhythm disorders
• Do we have the right drug?
  • Mechanism of heart reduction by ivabradine
• Where to start, where to go?
  • The Rotterdam Study: Resting heart rate and the risk of heart failure in healthy adults
  • The DIAMOND study: Resting heart rate and mortality in heart failure post MI patients
  • Metanalysis: effect of change in heart rate and achieved heart rate on clinical outcomes in HF
  • SHIFT trial: baseline heart rate is a predictor of endpoints on placebo
• How to do it?
  • Data from SHIFT study and a post-hoc analysis stating that chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure
  • Short-term effects of ivabradine on LV function
  • Short and long term hemodynamic effects of beta blockade differ
  • Clinical problem solving: facilitating beta blocker uptitration
• What do the guidelines say?
  • SHIFT trial and secondary analysis
  • Ivabradine recommended as the anti-anginal of choice, on top of a beta blocker for heart failure patients with angina

The presentation ends with the following notes:

• Heart rate is dysregulated by genetic background and neuroendocrine activation
• It is not a physiological reaction to support cardiac output, target 50-60 bpm.