Pumping Marvellous

Ivabradine (Procorolan) for Heart Failure

The National Institute for Health and Clinical Excellence (NICE) is issuing final draft guidance recommending ivabradine (Procoralan) as a treatment option for some people with chronic heart failure.

Treatment for heart failure is designed to help improve life expectancy, quality of life and to avoid hospital admissions. We feel this decision is long overdue and is great news for some patients.

Ivabradine evidence

The heart-rate-lowering drug ivabradine significantly reduced the risk of cardiovascular death and hospital admissions for worsening heart failure when added to standard treatment in patients, according to a UK, US and European study in 2010.

The ‘Systolic Heart Failure treatment with the ivabradine Trial’, known as SHIFT, looked at whether lowering heart rate with ivabradine reduces cardiovascular death and admission to hospital.

The patients studied had worsening heart failure, chronic heart failure, systolic dysfunction and a high heart rate over 70 beats per minute (bpm) or higher.

6,505 patients from 37 countries were studied over around 23 months. Around half were randomly given ivabradine twice daily in addition to standard heart failure treatments. The other half had a dummy placebo treatment added instead.

Treatment with ivabradine significantly reduced the risk of major heart failure by 18% compared to the dummy treatment. 16% of patients taking ivabradine were admitted to hospital with worsening heart failure compared to 21% in the placebo group. 3% of patients in the group taking ivabradine died from heart failure compared to 5% taking the placebo.

Ivabradine brought about an average reduction in heart rate of 15 bpm.

Who would get the new treatment?

The new guidance covers ivabradine for people with classes of chronic heart failure called NYHA class II to IV and other restrictions. The new guidance says ivabradine is cost effective when used in combination with standard therapy, including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blockers are not appropriate.

The decision to use ivabradine would be taken by a heart failure specialist. The treatment would cost the NHS around £42 per patient a month.

For this cost compared to a hospital admission makes economic sense. Be aware if you have AF then ivabradine will not be prescribed.

Image via Wikipedia

Boney M‘s Bobby Farrell died of heart failure

Heart failure caused the death of 1970s disco icon Bobby Farrell in a Saint Petersburg hotel room this week, his agent said Friday citing Russian authorities.

“It was heart failure,” agent John Seine told AFP by telephone from the northern Dutch town of Heemstede.

Steine said he had received an email Friday lunchtime from Euromed, a medical institution holding Farrell’s body in a Saint Petersburg mortuary, to report the findings of a post-mortem investigation by Russian authorities.

Farrell, 61, was found dead in his bed by a hotel employee on Thursday morning, having given a performance the night before during which he reported feeling unwell.

A Dutch national born on the Caribbean island of Aruba, Farrell was the sole male member of Boney M, which won global fame with catchy disco numbers like “Belfast”, “Ma Baker“, and “Rasputin”.

The group sold more than 50 million singles and 60 million albums worldwide.

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Cardioversion here we come

Just had my initial consultation with Angela Graves my Heart Failure Nurse and Dr John McDonald my cardio consultant who has just set the date for for my Cardioversion.

Can’t say I am completely looking forward to it, I still have an aversion to needles when I have my general anaesthetic but I realise that it could take me out of AF and back into Sinus Rhythm so I suppose this is a really good thing. The only big decision I had to make was taking Amiodarone.

Amiodarone is an Anti-Arrhythmic drug that has some quite perturbing side effects and I will let you investigate that. It has a half life of 45 days which means in layman’s terms it doesn’t get into your body for 45 days and therefore takes a long time to exit as well. Therefore John McDonald and I have agreed that I start off on 200mg of Amiodarone and continue this until I get my Cardioversion on the 25th November, if I don’t make it into to Sinus Rhythm and stay in AF then I will come off Amiodarone or if I go into Sinus Rhythm then I stay on Amiodarone for 90 days and no more. This is to enable my heart to have the best possible chance of staying in Sinus Rhythm. The reason for taking the Amiodarone before Cardioversion is that it increases the chances by 15-20% of the heart going into sinus rhythm from an electrical Cardioversion. It then keeps the heart stable by trying to prevent a flip over to AF again.

So lets give it a go and keep abreast of my shocking performance!!!!! It reminds me of that Carry on Film Carry on Screaming when Kenneth Williams says the famous line “Frying Tonight”

What I will stress is that to have these levels of discussion you need to have the right relationship with your Consultant and Nurse. Both John and Angela are very supportive but probably think I ask too many questions. Because I challenge my clinicians I am an expert patient – you should try it.

Amiodarone – a brief explanation

Amiodarone is a drug that slows the electrical impulses to the heart. These impulses tell the heart how fast to beat and in what rhythm. It is mainly used for people with irregular heart rhythms (arrhythmias), but there is some evidence it can benefit patients with heart failure. However, no large and convincing studies have been done. Your GP probably will not prescribe amiodarone, but a heart specialist might.

For further reading visit our pharamcy page

There are lots of weird and wonderful phrases and words when it comes to everything heart related.

This is a concise list of some Technical Terms –

Anti-arrhythmic – this is a drug to control a disorder of the heart rhythm

Arrhythmia – a disorder of the heart rhythm

Atherosclerosis – the build up of fatty material within the walls of the arteries

Bolus injection – When a drug is injected directly into a vein

Cholesterol lowering drug – a drug to lower the blood cholesterol level

Coronary Heart Disease – When the walls of the arteries become narrowed by a gradual build up of fatty material called atheroma

Coronary Thrombosis – The formation of a clot in the coronary arteries which can cause a heart attack. It is also a name used instead of heart attack

Enzymes – proteins that help to stimulate chemical actions in the body

Fibrin – a protein formed by clotting factors in the blood to act as part of the clotting process

Generic name – this is the actual name of the drug

HDL Cholesterol – high density lipoprotein. Sometime known as the protective cholesterol

Heart Failure – when the pumping action of the heart is less efficient

Heart Rate – number of beats per minute

Hypertension – high blood pressure

Intramuscular – into a muscle

Intravenous – into a vein

LDL cholesterol – low density lipoprotein. Sometimes known as bad cholesterol

Lipid drug – a drug to lower the level of cholesterol or triglycerides in the blood

Myocardial infarction – Heart attack

Platelets – small blood cells which are important for helping the blood clot.

Proprietary name – this is the trade name of the drug

Sublingual – under the tongue

Triglycerides – a type of fatty substance found in the blood