Updated Management of

Acute Heart Failure

Based on 2016 ESC and 2013/2017 AHA Guidelines,
plus role of Ivabradin

Dr. Muhammad Ridwan, MAppSc, SpJP (K) FIHA

Presented on GINIAKU 2, 13 October 2018

Dramatic increase of HF burden

Heart failure has been singled out as an emerging epidemic, which could
be the result of increased incidence and/or increased aging and survival
leading to increased prevalence

62 million HF

1 in 5 adults over 40
years will have HF in
their lifetime Gho J.M.I.H. Eur J Heart Fail. 2016;18 (suppl. 1): 442 (A1849)
 Heart failure is as malignant as cancer
≈50% of HF patients will die within 5 years

Data from contemporary Primary Care database of 56 658 patients from Scotland

Mamas MA et al. Eur J Heart Fail. 2017;19(9):1095-1104

 Heart failure is the leading Cardiovascular reason for
rehospitalizations

41,413 patients of the Italian National Health Service (INHS) database

Total number of re-admissions during 1 year = 48 549 (2.1 per patient)

CV reasons = 24 723 (50.9%)

The real-world evidence of heart failure: findings from 41 413 patients of the ARNO Database, European Journal of Heart Failure (2016)
 Acute HF
• AHF refers to rapid onset or worsening of
symptoms and/or signs of HF.
• It is a life-threatening medical condition
requiring urgent evaluation and treatment,
typically leading to urgent hospital admission.
Based on 2016 ESC and 2013/2017 AHA
Guidelines
 Ivabradine recommended in Panduan Praktek Klinis PP
PERKI 2017

Diuretics

ACE Inhibitor Ivabradine

-Blocker (Bisoprolol, Carvedilol) NYHA class II-IV

Heart rate ≥70 bpm (sinus rhythm)
Un-tolerated / contraindication
with Beta Blocker

Panduan Praktik Klinis & Clinical Pathway PP PERKI 2016

 Ivabradine Improves survival in patients with SR and
HR>75

Böhm M, Borer J, Ford I. et al. Analysis from the SHIFT study. Clin Res Cardiol (2013) 102:11–22
 Reduces heart failure symptoms, limitations, and
signs of decompensation

Rapid improvement of symptoms

Ivabradine Ivabradine Ivabradine

Zugck C, et al. Adv Ther. 2014;31(9):961-974
 Rapidly improves exercise capacity

Ivabradine

Bagriy AE et al. Adv Ther. 2015;32:108-119

 Improvement of all dimensions of quality of life

Patients feel better

Ivabradine Ivabradine Ivabradine

Zugck C et al. Int J Cardiol. 2017;240:258-264

 Rapidly improves ejection fraction
Early combination with β-blockers, before discharge in stable patients

Ivabradine

Ethical 1-year follow-up

Hidalgo FJ, et al. ETHIC-AHF: A randomised study. Int J Cardiol. 2016;217:7-11

 Acts in synergy with β-blockers and rapidly improves
systolic function

1. De Ferrari GM et al. Eur J Heart Fail. 2008;10:550-555. 2. Sarullo FM et al. J Cardiovasc Pharmacol Ther. 2010;15(4):349-355.
3. Kukin ML et al. Am Heart J. 1999;138:261-268. 4. Hall AS et al. JACC. 1995;25:1154-1161
Take Home Messages
• Acute Heart Failure has high mortality rate, thus early
adequate management is very important.
• There’s a significant increase in HF burden so that it’s essential
to improve patients’ survival by preventing rehospitalization
• The key strategy to optimize HF treatment should be started
as soon as patient is hospitalized for the first time
• HF patient with SR and HR > 75 bpm should be considered to
be given optimize therapy including Ivabradine
Thank you