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Coralan Experience (CORE) Survey - First Malaysian Experience of Ivabradine in Stable Angina

Gim-Hooi Choo, Ahmad Nizar Jamaluddin, David Kwang-Leng Quek and Tan Beng Hong

Aims: This non-randomised observational study primarily sought to evaluate the initial experiences with Ivabradine in these patients in terms of its efficacy in angina-related endpoints as well as highlighting safety issues, if any. This study also describes the profile of patients with stable angina pectoris. Methodology: Patients with angina pectoris and baseline HR above 70 bpm were recruited. Ivabradine 5 mg bd was added to baseline treatment, and further dose increment to 7.5 mg bd after 1 month if the HR remains above 70 bpm. Follow-up assessments were made at 2 time-points after initial recruitments i.e. after 1 and 2 months. Haemodynamic effects on blood pressure and HR were measured. Angina related parameters were assessed via patient interview. Safety issues were also reported. Results: 304 patients were recruited. There is a high prevalence of underlying hypertension (65.1%) and diabetes mellitus (46.4%). More than half (53.3) of the patients were already on baseline beta-blocker therapy. As expected, ivabradine use resulted in the significant reduction in HR from 81.7 ± 13.8 bpm to 67.0 ± 8.9 bpm without significant change in the BP measurements. All angina severity indicators e.g. number of angina episodes, use of short-acting nitrates and angina class improved. Side-effects were uncommon. This treatment was well tolerated and accepted by most patients. Conclusion: Ivabradine as a pure HR-reduction agent is an efficacious strategy for angina improvement with minimal concerns of safety and side-effects. This early experience of Ivabradine use and its effects in Malaysia was in concordance with currently available clinical evidence.