£10 pill gives hope to heart failure patients

A £10-a-week pill for chest pains has the potential to save the lives of thousands of heart failure patients and slash the cost of hospital admissions, trial results have shown.

One expert described the evidence as a "significant breakthrough" and said it would compel him to change his clinical practice.

At a conservative estimate, up to 10,000 deaths a year in the UK could be prevented, he said.

The drug, ivabradine, is already available in the UK for angina, the pain caused by insufficient blood reaching the heart. However, only around 10 per cent of treated angina patients are prescribed it.

Results from an experts' meeting in Stockholm suggest that ivabradine could be resurrected as a cost-effective treatment for many thousands of patients with moderate to severe heart failure.

Over a typical study period of two years, the drug cut the risk of death from heart failure by 26 per cent in the patient population studied. It had a similar impact on the likelihood of being admitted to hospital because of worsening symptoms.

More than 700,000 people over the age of 45 live with heart failure, which occurs when damage to the heart leaves it too weak to pump blood efficiently round the body.

An estimated 68,000 new cases are diagnosed each year. Heart failure causes symptoms of fatigue, breathlessness, increased heart rate, and swollen ankles. It can lead to serious complications, and around 40 per cent of those affected are dead after a year. Heart failure soaks up 1-2 per cent of the total NHS budget, with direct medical costs alone amounting to 625 million a year.

The Shift (Systolic Heart failure treatment with the If inhibitor ivabradine Trial) trial involved more than 6,500 patients in 37 countries already on standard treatments such as beta-blocker drugs.

Participants were randomly assigned additional varying doses of ivabradine, or placed in a "control group" receiving standard treatment only. All the patients had chronic heart failure and a high heart rate of 70 beats per minute or more.

The findings were presented at the European Society of Cardiology annual meeting in Stockholm.

Results from the trial were also published in a special online edition of The Lancet medical journal. The researchers, led by Professor Karl Swedberg from Sahlgrenska University Hospital in Goteborg, Sweden, wrote: "Ivabradine substantially and significantly reduced major risks associated with heart failure when added to guideline-based and evidence-based treatment."

The key to ivabradine is its effect on heart rate. Unlike other treatments, such as beta-blockers, it lowers the number of heart beats per minute without also reducing blood pressure.

It also has a very good safety profile, according to the evidence.In the trial, fewer patients taking ivabradine suffered serious side effects than those on other medications.

Treating a single patient with the drug costs around 10 a week, making it an affordable alternative. Professor Martin Cowie, consultant cardiologist at the Royal Brompton Hospital in London, who led the UK arm of the study, said: "The evidence represents a significant clinical breakthrough in the management of heart failure and is incredibly important information for patients with this condition.

"We now know that more lives can be saved and improved simply by adding ivabradine to their current treatment in order to take some of the strain off the heart. It is vital that the results of this study are implemented and ivabradine is used as part of standard heart failure treatment as soon as possible."