Divchev D, et al. - Researchers performed this prospective, multicenter, observational cohort study on stable angina pectoris (AP) patients in a clinical practice setting in order to determine the efficacy as well as tolerability of the first fixed-dose combination (FDC) formulation of the selective heart rate reducing agent ivabradine and the beta-blocker metoprolol in these subjects. In association with the implementation of this treatment strategy ( FDC of ivabradine and metoprolol), reduced heart rate (HR) and angina symptoms were evident in the patients, while exercise capacity (CCS score) was improved. Data also indicated that these impacts may be mainly mediated by the increased medication adherence of patients observed with use of the FDC formulation.

Methods

• Study participants viz, stable AP outpatients received a FDC of ivabradine and metoprolol (b.i.d.) for 4 months, in addition to cardiovascular standard therapy.
• Researchers documented resting heart rate (HR), number of angina attacks, short-acting nitrate consumption, severity of symptoms (assessed by patient judgment and documented by CCS score) and tolerability.
• Using a modified four-item Morisky questionnaire, they assessed medication adherence.
• They also performed descriptive statistics on all data.

Results

• This analysis included a total of 747 stable AP patients (mean age, 66.4 years, 62% male, 50% and 31% with previous PCI and myocardial infarction, respectively).
• Findings demonstrated that aspirin (68%), statins (71%), ACEI/AT1-blockers (76%), diuretics (35%), and calcium antagonists (15%) were identified as most frequently used concomitant standard medications at baseline, apart from ivabradine and beta-blockers as free combination.
• Hypertension (86%), hyperlipidemia (65%), and diabetes (35%) were recognized as highly prevalent comorbidities.
• Researchers observed that after 4 months, switch to treatment with the FDC was related to a significant reduction in mean HR by 10 bpm.
• A decrease (from 38 to 7%) was reported in the proportion of patients with ≥ 1 angina attacks/week.
• Data showed that patients in CCS class 1 increased (25 to 63%), while they decreased in CCS class 3 (19 to 5%).
• A significant improvement in medication adherence was also observed (p < 0.001 for all changes from baseline).
• In addition, in 5.4% of patients, mostly mild adverse events were documented.