Who is the most suitable candidate for ivabradine therapy?

The most suitable candidate for ivabradine therapy is an individual with symptomatic heart failure and a resting heart rate of 70 beats per minute or higher. Ivabradine specifically targets heart rate reduction in patients with heart failure who are in sinus rhythm and cannot tolerate or achieve sufficient heart rate control with beta-blockers.

In this scenario, the individual with NYHA class III heart failure and a heart rate of 78 bpm meets the criteria necessary for ivabradine therapy. NYHA class III indicates significant limitation due to heart failure symptoms, while the heart rate is above the threshold required for ivabradine to be beneficial.

Ivabradine's indication is particularly focused on patients with stable chronic heart failure and a reduced ejection fraction, who are symptomatic despite optimal treatment, including beta-blocker therapy. It can help improve outcomes in these patients by reducing the risk of hospitalization and improving quality of life.

The other candidates do not meet the criteria for ivabradine suitability due to either having a lower heart rate or being in a NYHA class that suggests less severe heart failure. For instance, the 55-year-old man with class I heart failure shows minimal symptoms and has a heart rate of 75 bpm, which is not optimal for initiating ivabradine