Slow Down That Racing Heart: A Comparison of Ivabradine Versus Digoxin for the Treatment of Chronic Heart Failure
Background: Heart failure (HF) is a chronic condition in which the heart cannot pump blood effectively enough to meet the demands of the body. Pharmacological treatment focuses on reducing the workload of the heart, reducing heart rate, increasing cardiac output, decreasing edema, and reducing mortality. Angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), aldosterone antagonists, and beta blockers are medication classes commonly used in the treatment of heart failure. Other treatment options include the use of digoxin and ivabradine. Objective: Digoxin and ivabradine are both utilized to further reduce heart rate uncontrolled by the standard of care. However, digoxin and ivabradine differ based on mechanism of action, effect on left ventricular ejection fraction, drug interactions, costs, and adverse effects. Discussion: Digoxin and Ivabradine have both been shown effective at lowering heart rate and treating some of the symptoms associated with chronic heart failure. Digoxin has been on the market longer, contributing to a more extensive knowledge of its safety and efficacy as compared to ivabradine. However, the SHIFT trial provides evidence that ivabradine can reduce hospitalizations. There are fewer drug interactions associated with ivabradine and drug level monitoring is not required. Nevertheless, ivabradine adverse effects may significantly impact heart failure patients. Conclusion: Ivabradine is appealing with respect to its ability to reduce hospitalizations in patients with heart failure, as well as its ease of dosing and monitoring. However, due to its increased cost and lack of extensive use, digoxin may provide a more cost effective option for many patients.
Lillian Smith, Juan Mosley*, Megan Ford, Jonathan Courtney, Chase Stefanelli
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