Targeted heart rate control using the funny current inhibitor ivabradine to reduce morbidity in patients undergoing non-cardiac surgery: a phase IIa, triple blind, placebo controlled randomised trial

 

The development of serious medical problems after surgery (e.g. damage to the heart) can adversely affect the patient's care particularly in the older more vulnerable population. A poor postoperative outcome not only delays patient recovery but poses longer-term health concerns such as loss of mobility and independence. There is a clear and urgent need to improve perioperative care to effectively improve patient outcomes.

 

We know patients who are most vulnerable to developing complications often have problems with a specialised nerve that helps control their heart beat. A key feature in these patients is a higher heart beat, which is strongly associated with heart damage and coincides with other organs of the body not working normally. However current treatments that slow heart rate (e.g. beta-blockers) can result in further damage being done because of indirect effects caused by these drugs on blood pressure and other functions.

 

Our aim is to establish whether the specific lowering of a patient’s heart rate during their perioperative care (the care before, during and after surgery) will protect them from damage to the heart and reduce the development of further complications. In this trial, the drug ivabradine will be used which slows heart rate only. We will invite 350 patients having surgery that does not involve the heart to take part. We will randomly allocate them (like a coin toss) to receive ivabradine tablets or placebo tablets from the day of surgery until postoperative day three. After surgery, researchers who don’t know which patients have been given ivabradine will measure their safety and well being.

 

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