Digoxin Versus Ivabradine in Heart Failure With Reduced Ejection Fraction

Comparing the Effects of Digoxin and Ivabradine on Mortality and Morbidity in Chronic Heart Failure With Reduced Ejection Fraction and Sinus Rhythm

Study hypothesis: Comparing the effect of digoxin and ivabradine in chronic heart failure patients with a left ventricular ejection of 35% or lower and sinus rhythm with heart rate 70 beats per minute or higher, and who are taking maximal dose of a beta blocker if tolerated.

Selected patients have chronic heart failure with left ventricular systolic dysfunction and sinus rhythm. They take optimal medical therapy.

1. Inclusion Criteria:

   • Left ventricular ejection fraction of 35% or lower (Ischaemic or non-ischaemic etiology)
   • Sinus rhythm with heart rate of 70 beats per minute or higher
   • Symptomatic heart failure with functional capacity of New York Heart Association class II, III, IV

2. Exclusion Criteria:

   • Chronic renal failure with glomerular filtration rate <30 ml/min
   • Atrial fibrillation
   • Pace maker rhythm
   • Advanced stage chronic obstructive lung disease
   • Comorbidity with expected survival below 1 year