Bài giảng với các nội dung: hai liệu pháp dược lý mới được FDA chấp thuận cho bệnh suy tim, dòng thời gian phê duyệt Ivabradine, thời gian chuẩn độ như được xác định trong các thử nghiệm mang tính bước ngoặt, lý do không đạt được liều đích, hiệu quả điều trị của Ivabradine theo huyết áp. | Bài giảng Suy tim mạn góc nhìn từ ACC 2017 - Châu Ngọc Hoa Suy tim mạn: GÓC NHÌN TỪ ACC 2017 PGS TS Châu Ngọc Hoa Bộ môn Nội ĐHYD Tp HCM ACC Focused update on HF, 2017 Two New Pharmacological Therapies Approved by FDA for Heart Failure • Ivabradine (April 15, 2015) • Sacubitril/Valsartan (July 7, 2015) WHO, WHEN AND WHY ADD ON IVABRADINE Ivabradine approval timeline • 2005 approved in EU for angina • 2012 approved in EU for heart failure • 2015 approved in US for heart failure to reduce the risk for hospitalization for worsening heart failure in patients with stable, symptomatic chronic heart failure with LVEF ≤35%, who are in sinus rhythm with a resting heart rate of ≥70 beats per minute (bpm) and are taking maximally tolerated doses of beta-blockers or have a contraindication to beta-blockers. Ivabradine Blocks If channel Slows heart rate Few if any other CV effects SHIFT Trial > 6500 HF patients (NYHA II-IV) LVEF < 35% Resting HR > 70 BPM Primary endpoint: composite of CV death/HF hospitalization On maximally tolerated beta-blocker SHIFT: primary outcome CV death or hospitalization for HF (%) 40 HR= pSHIFT: HF hospitalization Hospitalization for HF (%) 30 Placebo HR= 20 10 Months 6 12 18 24 30 Swedberg K, et al. Lancet. 2010;376:875-885. Ivabradine in HF Up-titrate beta blocker dose as much as possible Add on therapy to beta blocker; not replacement Does not lower blood pressure Contraindicated in atrial fibrillation Benefit greater in patients with higher baseline heart rate Target doses as defined in the ESC guidelines Startingdose(mg) Targetdose(mg) ACEI Enalapril Lisinopril Ramipril Beta-blocker Bisoprolol Carvedilol Metoprololsuccinate MRA Eplerenone Spironolactone IfInhibitor Ivabradine .
