A 58-year-old man with HFrEF (EF 30%) remains symptomatic in sinus rhythm at a resting heart rate of 82 bpm despite maximally tolerated bisoprolol. Which drug can be added to reduce hospitalization for worsening heart failure?
- A Ivabradine ✓
- B Digoxin
- C Amiodarone
- D Ranolazine
Correct answer: A. Ivabradine
Explanation
Ivabradine selectively inhibits the sinoatrial If current, lowering heart rate without affecting blood pressure or contractility. The SHIFT trial showed reduced cardiovascular death and heart failure hospitalization in patients with EF 35% or less, sinus rhythm, and resting rate 70 bpm or more on maximally tolerated beta-blocker. Amiodarone and digoxin do not reduce mortality, and ranolazine is an antianginal without heart failure benefit.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.