• Hemanth Kumar lekkala Creative Educational Society's College of Pharmacy


the objective of this study was to assess the role of heart rate in acute coronary syndrome with reduced ejection fraction, to assess contraindications for beta blockers, to assess the tolerability between Ivabradine and Beta-Blockers, to assess efficacy between Ivabradine and Beta Blockers, to assess patient condition according to NYHA classification.

Methods: A Prospective observational study was conducted for a duration of6 months Study population includes 100 patients in which Group A-50, Group B-50. We were selected the subjects according to inclusion and exclusion criteria. The patients were classified in one of four categories based on their symptoms in regards to normal breathing and varying degrees in shortness of breath by using (The New York Heart Association) NYHA Classification.

Results: Majority of the patients were in age group between (55-64)(32%) years of age are highly affected with ACS. Prevalence of ACS is high in Rural (56%). Both drugs decreased the mean heart rate to 89.97±10.27 (Group-A) versus 86.76±13.14 (Group-B) beats per minute (P=0.24). The result obtained are clinically and statistically significant with statistical significance at P>0.05.

Conclusion:  In the present study we considered and compared the efficacy between Ivabradine and Beta Blockers in south Indian acute coronary syndrome patients shows Ivabradine is as effective as betablockers in reduction of heart rate.



Keywords: KEY WORDS: Ivabradine, Cardiogenic shock, Beta blockers, Pulmonary edema.


1. clinical management guideline for coronary artery disease for national programme for prevention and control of diabetes, cardiovascular disease and stroke.
2. Gupta R. Burden of Coronary Heart Disease in India. Indian Heart J 2005; 57:632638
3. Kumari priti et al. Ivabradine versus metoprolol in patients with acute inferior wall myocardial infration-“Exapnding arena for ivabradine”. Cardiovasc ther. 201735:e12266.
4. Kanu Chatterjee, Eric j Topol CARDIAC DRUGS, 2nd edition-2015, Page number:280-282, 385-386, 467.
5. Luminita Iliuta. Marius Rac-Albu.Ivabradine versus Beta-Blockers in patients with conduction abnormalities or left ventricular dysfunction undergoing cardiac surgery 2014;3:13-26.
6. Pawel Ptaszynski et al. Metoprolol succinate versus. Ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy 2013;15,116-121.
7. Sergio Fasullo,MD et al. Comparison of Ivabradine versus Metoprolol in Early Phases of Reperfused Anterior Myocardial Infarction With Impaired Left Ventricular Function: Preliminary Findings 2009;15:856-863.
8. S.Sulfi,A.D. Timmis. Ivabradine-the first selective sinus node If channel inhibitor in treatment of stable angina 2006,60,2,22-228.
9. Mona Fiuzet,PharmD et al. Heart Rate Or Beta-Blocker Dose ? Association With Outcomes In Ambulatory Heart Failure Patients With Systolic Dysfunction 2015.09.002
10. Jeffrey S.Borer,MD, Prakash C. Deedwania, MD, Jae B. Kim,MD, Michael Bohm,MD.Benifits Of Heart Rate Slowing With Ivabradine In Patients With Systolic Heart Failure And Coronary Artery Disease 2016.08.089.
11. Henry Krun et al. Tolerability of beta-blockers in elderly patients with chronic heart failure: The COLA II Study 2006;302-307.
12. G Heusch. Pleiotropic action(s) of the bradycardic agent ivabradine: Cardivascular protection beyond heart rate reduction 2008 ;155,970-971.
13. Jean-Claude Tardif, Piotr Ponilkowski, and Thomas Kahan. Efficay of the If current inhibitor Ivabradine in patients with chronic stable angina receiving Beta-Blocker therapy: A 4-month, randomised, placebo- controlled trail 2009;30,540-548.
14. Karl Swedberg,MD et al. Effects On Outcome Of Heart Rate Reduction By Ivabradine In Patients With Congestive Heart Failure: Is There An Influence Of Beta-Blocker Dose? 2012;59:1938-45.
15. Jeffrey S.Borer,MD et al. Efficacy And Safety Of Ivabradine In Patients With Severe Chronic Systolic Heart Failure(from the SHIFT study) 2014;113:497-503.
16. Maurizio Volterrani et al . Effect of Carvedilol, Ivabradine or their combination on exercise capacity in patients with heart failure (the CARVIVA HF trail ) 2011;218224.
17. Karl Swedberg et al. Rationale and design of a randomised, double-blind, placebocontrolled outcome trail of Ivabradine in chronic heart failure: the Systolic Heart Failure Treatment with If Inhibitor Ivabradine Trail(SHIFT).2010;12,75-81.
18. Thygesen, K, Alpert, JS, White, HD, et al. Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Eur Heart J 2007; 28:2525.
19.Trehan N. Management of coronary artery disease in India. 2007
20. Enas EA, Garg A, Davidson MA et al. Coronary heart disease and risk factors in the first generation immigrant Asian Indians to the United States of America. Indian Heart Journal.1996;48:343-44
21. Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007; 297: 286–94.
22.Vallapuri S, Gupta D, Talwar KK, Billie M, Mehta MC, Morise AP, Jain AC. Comparison of atherosclerotic risk factors in Asian Indian and American Caucasian patients with angiographic coronary artery disease. Am J Cardiol2002;90:1147– 1150
23. Available at.https://zdoc.site/effect-of-metoprolol-and-ivabradine onleft.html (access ed on22-11-19).
24. Available at.https://www.physiology.org/doi/pdf/10.1152/ajpheart.01337.2008 Available at.https://zdoc.site/effect-of-metoprolol-and-ivabradine-onleft.html(accessed on22-11-19)
25. Camm AJ, Lau CP. Electrophysiological effects of a single intravenous administration of ivabradine (S 16257) in adult patients with normal baseline electrophysiology. Drugs R D. 2003;4:83?89.
26. DiFrancesco D, Camm JA. Heart rate lowering by specific and selective I(f) current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs. 2004;64:1757?1765.
27. Tardif JC, Ford I, Tendera M, et al. Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26:2529?2536.
28. Tardif JC, Ponikowski P, Kahan T, for the ASSOCIATE study investigators. Efficacy of the if current inhibitor ivabradine in patients with chronic stable angina receiving beta?blockers therapy: a 4?month, randomized placebo?controlled trial. Eur Heart J. 2009;30:540?548.
29. Swedberg K, Komajda M, Böhm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo?controlled study. Lancet. 2010;376:875?885.
30. Fasullo S, Cannizzaro S, Maringhini G, et al. Comparison of ivabradine versus metoprolol in early phases of reperfused anterior myocardial infarction with impaired left ventricular function: preliminary findings. J Card Fail. 2009;15:856?863.
31. Gerbaud E, Montaudon M, Chasseriaud W, et al. Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: a pilot study. Arch Cardiovasc Dis. 2014;107:33?41.
32. Camm AJ, Lau CP. Electrophysiological effects of a single intravenous administration of ivabradine (S 16257) in adult patients with normal baseline electrophysiology. Drugs R D 2003;4:83e9
33. DiFrancesco D, Camm JA. Heart rate lowering by specific and selective I(f) current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs 2004;64:1757e65.
34. Custodis F, Baumha¨kel M, Schlimmer N, List F, Gensch C, Bo¨hm M, et al. Heart rate reduction by ivabradine reduces oxidative stress, improves endothelial function, and prevents atherosclerosis in apolipoprotein E-deficient mice. Circulation 2008;117:2377e87.
35. Maczewski M, Mackiewicz U. Effect of metoprolol and Ivabradine on left ventricular remodelling and Caþ handling in the post-infarction rat heart. Cardiovasc Res 2008;79:42e51.
36. Langenbach MR, Schmitz-Spanke S, Brockert M, Schepan M, Pomblum VJ, Gams E, et al. Comparison of a beta-blocker and an If current inhibitor in rabbits with myocardial infarction. J Cardiovasc Surg (Torino) 2006;47:719e25
37. Heusch G, Skyschally A, Gres P, van Caster P, Schilawa D, Schulz R. Improvement of regional myocardial blood flow and function and reduction of infarct size with ivabradine: protection beyond heart rate reduction. Eur Heart J 2008;29:2265e75.
38. Manz M, Reuter M, Lauck G, Omran H, Jung W. A single intravenous dose of ivabradine, a novel I(f) inhibitor, lowers heart rate but does not depress left ventricular function in patients with left ventricular dysfunction. Cardiology 2003;100:149e55.
39. Borer JS, Fox K, Jaillon P, Lerebours G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation 2003;107:817e23
40. De Ferrari GM, Mazzuero A, Agnesina L, Bertoletti A, Lettino M, Campana C, Schwartz PJ, et al. Favourable effects of heart rate reduction with intravenous administration of ivabradine in patients with advanced heart failure. Eur J Heart Fail 2008;10:550e5 .
108 Views | 20 Downloads
How to Cite
lekkala, H. K. “A PROSPECTIVE CONSIDERATIONS AND COMPARATIVE EFFICACY BETWEEN IVABRADINE VS BETA BLOCKERS IN SOUTH INDIAN ACUTE CORONARY SYNDROME PATIENTS ”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 1, Nov. 2019, pp. 193-5, https://innovareacademics.in/journals/index.php/ajpcr/article/view/34480.
Original Article(s)