Ivabradine pill may prevent heart failure for thousands

Blood pressure measurement
Image caption Ivabradine lowers heart beat rates without reducing blood pressure

A pill costing less than £1.50 a day has the potential to save the lives of thousands of heart failure patients, medical trials suggest.

The drug, ivabradine, is already available in the UK to treat angina.

Prof Martin Cowie, who led the UK-based part of the study, said it could save up to 10,000 lives each year.

The trial involved more than 6,500 people in 37 countries who already used standard treatments such as beta-blocker drugs.

Over a typical study period of two years, ivabradine cut the risk of death from heart failure by 26%.

It had a similar impact on the likelihood of patients being admitted to hospital.

The research findings were presented at the European Society of Cardiology (ESC) annual meeting in Stockholm.

More than 700,000 people over the age of 45 are thought to live with heart failure, which occurs when damage to the heart leaves it too weak to pump blood efficiently round the body.

Heart failure uses up 1% to 2% of the total NHS budget and direct medical costs alone amounting to £625m each year.

Unlike other treatments, such as beta-blockers, ivabradine lowers the number of heartbeats per minute without also reducing blood pressure.

'Clinical breakthrough'

Prof Cowie, a consultant cardiologist at London's Royal Brompton Hospital, described as conservative estimates that 10,000 deaths could be prevented in the UK by prescribing the drug to eligible patients.

He told BBC Radio 4's Today programme that one in four people in the UK could develop heart failure in some point in their lives.

The drug worked by slowing the pulse down so that it helped to take some of the strain off the heart, he said.

"For people who have heart failure, their heart is always going too fast. Even when they are sitting doing nothing, their heart rate might be going along at 80 or 90 beats per minute and this drug helps slow that down," he added.

"In the past we have been able to do that with drugs called beta blockers... but many patients can't take beta blockers because they have asthma or it drops their blood pressure.

"This drug has the advantage that it can be added to beta blockers or it can be given to people who can't take them.

"It slows the pulse rate without dropping the blood pressure or affecting any asthma, so it's a very exciting new option for doctors and patients to think about if they have heart failure."

'Further research'

He stressed the drug was not suitable for everybody, but only those who already had a serious heart condition.

He said: "The evidence represents a significant clinical breakthrough in the management of heart failure and is incredibly important information for patients with this condition."

"It is vital that the results of this study are implemented and ivabradine is used as part of standard heart failure treatment as soon as possible."

Although ivabradine is already available in the UK for angina - the pain caused by insufficient blood reaching the heart - it is only prescribed to about 10% of patients with the condition.

But Dr John Teerlink, a cardiology expert based at the University of California in San Francisco urged caution.

In a commentary article in the medical journal The Lancet - which also published the ivabradine research - he asked if all the patients in the control group were being "optimally treated" with standard medications.

He said: "Ivabradine therapy might reduce heart-failure hospitalisations when added to contemporary heart-failure therapies.

"However, whether ivabradine can improve outcomes in addition to optimally managed heart failure therapies or its benefits relative to other therapies, especially beta blockers, remains unknown."

He said more research had to be carried out and added: "Many unresolved questions about the generalisability of these results and applicability to a broader population of patients can only be addressed in additional clinical trials."

The call for further research was echoed by British Heart Foundation medical director Prof Peter Weissberg.

He said: "The medical treatment for the condition has improved substantially over recent years, but it still has a poor outcome.

"This important study suggests that a new drug, that works by lowering heart rate, may offer improvements over currently available treatments.

"Further studies are now needed to establish its role in heart failure management."

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