Ivabradine for the treatment of stable angina pectoris in octogenarians
In patients >80 years (octogenarians), there is an increased incidence of bradycardia due to age-related alteration of the sinus node, AV node, and the conduction system. Therefore, the treatment of angina pectoris with beta-blockers may be limited by bradycardia. The REDUCTION multicenter study evaluated the efficacy of ivabradine in stable angina pectoris in everyday practice. This subgroup analysis evaluated the efficacy and safety of ivabradine in octogenarians. A total of 4,954 patients were included in the REDUCTION study for treatment of stable angina pectoris. This group included 382 octogenarians (mean age 83 ± 2.9 years) who were followed up over 4 months. Patients were treated with ivabradine in flexible doses (2.5, 5, or 7.5 mg bid). Heart rate (HR), angina pectoris attacks, nitrate consumption, overall efficacy, and tolerance were evaluated. After 4 months of treatment with ivabradine, HR was reduced by 12.0 ± 12.0 bpm from 83.0 ± 15.4 to 71.0 ± 10.1 bpm (p < 0.0001). Angina pectoris attacks were reduced from 3.0 ± 4.6 to 0.8 ± 1.8 per week (p < 0.0001). Consumption of nitrates decreased from 4.2 ± 5.1 to 1.2 ± 2.7 (p < 0.0001). Four patients reported suspected adverse drug reactions. In one patient a syncope occurred. There was no symptomatic bradycardia reported. Efficacy and tolerance were assessed as ‘very good/good’ for 95 and 99%. The results demonstrate that ivabradine efficiently reduces HR, number of angina attacks, and nitrate consumption in octogenarian patients. The treatment was safe and well tolerated without relevant bradycardia.