Ivabradine improves quality of life in subjects with chronic heart failure compared to treatment with ß-blockers: results of a multicentric observational APULIA study.

OBJECTIVES: Ivabradine (IVA), a selective If current inhibitor decreasing the heart rate (HR) in patients with sinus rhythm, has been added to the most recent European Guidelines on heart failure. This selective treatment reduces HR exclusively while fully preserving myocardial contractility and relaxation, atrioventricular conduction, and ventricular repolarization, as well as blood pressure. The aim of this study was to evaluate the improvement of quality of life (QOL) in patients with chronic heart failure (CHF) treated with IVA versus two ß-blockers (bisoprolol and carvedilol). METHODS: We evaluated if a 1-month treatment with IVA (5 mg b.i.d.) or ß-blockers (carvedilol 6.25 mg b.i.d. or bisoprolol 1.25 mg b.i.d.) improves the QOL (assessed by SF-36 questionnaire) in patients with CHF with reduced left ventricular ejection fraction (<50%). SF-36 was tested in 221 CHF patients (mean age 64 ± 6 years) randomized into two groups (IVA group - 110 patients; ß-blockers group - 111 patients). Data of QOL questionnaire and HR were collected by an interview during a clinical visit both at prescription time (basal) and after 1 month of therapy with IVA or ß-blockers. QOL life and HR results after 1-month of therapy (T1) with IVA were compared with basal values (T0). RESULTS: The IVA versus ß-blockers treatment was associated with a significant improvement of physical functioning (p < 0.001 vs. p < 0.01), physical role functioning (p < 0.001 vs. p < 0.01), emotional role functioning (p < 0.01 vs. p < 0.85), and mental health scales (p < 0.001 vs. p < 0.01). HR in the IVA group was significantly lower compared to the group of patients treated with ß-blockers (63 vs. 67 bpm; p < 0.001). CONCLUSIONS: IVA treatment significantly improves the QOL in patients with CHF without any deleterious impact on hemodynamics, and may be beneficial in these patients without other adverse effects associated with ß-blockers.

[Green milk: a contribution to the study of iatrogenic pollution of human milk?]. / Latte verde: un contributo allo studio degli inquinamenti iatrogenici del latte di donna?

An heterozygotic beta-thalassemic pregnant woman after a treatment with ferritin produced green milk for many days. Bivalent iron was found in that green human milk.