Best of heart failure

55 management of t making. The patie compassionate bas benefits and side e their parents. 2 Methods We evaluated pa institution for who February 2008 to pharmacy databas starting the medi POTS was specifi heart rate increase 120 bpm within t with symptoms significant orthost age at commence up-titration, reaso treatment, medica medications with worsening of sym and at follow-up cardiogram (EKG dine and at follo 2.1 Statistical An Normally distribut and standard devi were described w pendent t test was nificant level was Table 1 Demographi clinician’s stated indi starting ivabradine 60 for POTS were evaluated. Animal studies and articles written in languages other than English were excluded. The titles and abstracts of the search results were first screened for possible inclusion. The full texts of these reports were then reviewed to determine final eligibility for inclusion in the systematic review. Authors (MEG and AKW) indepen- dently performed the literature review and study selection. Any disagreements were resolved by a third author (JNB). 2.3 Data Extraction Authors, publication date, study design, study location, patient demographics, ivabradine treatment dose and dura- tion, prior medication use for treatment of POTS, con- comitant medication treatment regimens, clinical outcomes including subjective (improvement of symptoms) and objective (change in HR) measures, and ivabradine-related adverse drug events were extracted from each included study using a standardized data extraction process. 3 Results 3.1 Study Selection Figure 1 describes the literature search. Initially, 73 articles were identified. After screening titles and abstracts and removing dup reviewed to consisted of t spective cohor use for POTS summary of i studies, and c 3.2 Literatur Barzilai and single-dose, patients with [ 13 ]. Orthosta of at least 30 more than 2 during a hea rences. Patien nancy, uncont history of syst function. Eig recruited wit 31 ± 3 years, duration of P participants taking propra ticipants were MEDLINE (n=19) Records after dup removed (n=6 Titles and abstracts (n=61) Full text articles ass eligibility (n=4 Articles include qualitative analysis Identi�ication Screening Eligibility Included Fig. 1 Flow diagram for reference search and selection of articles for analysis Ivabradine for the Treatment of Postural Orthostatic Tachycardia Syndrome 24 h prior to the start of study testing. The protocol consisted of a six-phase tilt test, with monitoring for orthostatic symptoms, BP, and HR occurring during each phase. The testing protocol was repeated 60–80 min fol- lowing a single 7.5 mg dose of ivabradine. All patients self-reported improvement of symptoms of orthostasis, including dizziness, blurred vision, and palpitations, after ivabradine administration. Post-tilt HR significantly decreased from 118 ± 4 bpm without treatment to 101 ± 5 bpm following ivabradine administration ( P \ 0.01). Resting HR decreased by 4 ± 1 bpm, but this was not a statistically significant reduction. Ivabradine did Table Summary of open-label trials and cohort studies evaluating outcomes of ivabradine in postural orthostatic tachycardia syndrome Author Study design No. of patients Ivabradine dose Treatment duration Outcome Results Adverse r actions Barzilai et al. [ 13 ] Prospective open-label 8 7.5 mg One time dose Proportion of patients ith I provemen in tilt test induced symptoms HR post head tilt test 100% ; 17 bpm ( P \ 0.01) NR Sutton et al. [ 14 ] Prospective open-label 23 Initial: 5 mg/day in 1–2 doses Range: 5–20 mg/day Mean: 10.7 mg/day Mean of 15 mon hs (Range: 2–40 months) Likert scale of sym tom improvement Complete resolu ion: 34.8% ( n = 8) Great improvement: 43.5% ( n = 10) No benefit: 21.7% ( n = 5) Deterioration: 0% Visual side effects 9% ( n = 2); study discontinuation due to unspecified side effect 4% ( n = 1) McDonald et al. [ 11 ] Retrospective cohort study 20 Initial: 2.5 mg once daily Range: 2.5–15 mg/day Mean: 5 mg/day Mean of 25 weeks (range: 7–113 weeks) Self-assessment tool for symptoms Improved palpitations: 55% ( n = 11) Improved tachycardia: 55% ( n = 11) Improved fatigue: 40% ( n = 8) Visual abnormalities: 10% ( n = 2) dizziness: 5% ( n = 1) fatigue 5% ( n = 1) Delle Donne et al. [ 15 ] Retrospective cohort study 22 Initial: 2.5 mg twice daily Range: 5–15 mg/day Mean: 9.5 mg/day Mean of 4.6 months (range: 0.9–17 months) Symptom response HR Improvement: 68.2% ( n = 15) Unchanged: 27.3% ( n = 6) Deterioration: 4.5% ( n = 1) ; 11.2 bpm ( P \ 0.05) Mild phosphenes: 4.5% ( n = 1) Ruzieh et al. [ 16 ] Retrospective cohort study 49 Initial: 2.5 mg twice daily Range: 2.5–10 mg twice daily Mean: 10.9 mg/day Range: 3–12 months Symptom response Sitting HR Standing HR Overall Improvement: 77.6% ( n = 38) Improved palpitations: 88.4% Improved lightheadedness: 76.1% ; 5.6 bpm ( P = 0.01) ; 12.3 bpm ( P \ 0.001) Phosphenes: 18% ( n = 9) Nausea: 8.2% ( = 4) bpm beats per minute, HR heart rate, NR not reported 198 M. E. Gee et al.