Heart Failure Drug Appears to Help COVID-19 ‘Long-Hauler’ Syndrome
Pharmacists and other healthcare professionals increasingly are dealing with “long-hauler” COVID-19 – an array of symptoms that continue long after the initial infection appears to have resolved. One of those is postural orthostatic tachycardia syndrome (POTS). Find out how effectively the heart failure drug ivabradine improves symptoms of the complex, debilitating disorder, according to a small study.
SAN DIEGO – A drug used for heart failure is showing promise for improving postural orthostatic tachycardia syndrome (POTS), which has been identified as a “long-hauler” symptom of COVID-19.
The report in the Journal of the American College of Cardiology suggests that the drug ivabradine improves symptoms of the complex, debilitating disorder which affects the body's autonomic nervous system. It can cause a high heart rate, usually when standing. Other symptoms of POTS include "brain fog," lightheadedness, palpitations, tremors, weakness, blurry vision and fatigue, according to University of California San Diego researchers.
POTS is typically caused by a viral infection, trauma, surgery or enforced bedrest, and most commonly affects young women who are either athletes or highly active, background information in the article notes. No Food and Drug Administration-approved treatments are currently available for the syndrome.
"Ivabradine is a novel agent that's FDA-approved for heart failure but based on its mechanism we thought it could be helpful for patients with POTS as it reduces heart rate without impacting blood pressure," explained Pam Taub, MD, cardiologist at the Cardiovascular Institute at UC San Diego Health and associate professor of medicine at UC San Diego School of Medicine. "When we can lower the heart rate, we're providing these patients with the ability to stand up, something they couldn't do without difficulty before due to their POTS diagnosis."
The small study investigated the effect of ivabradine, a selective blocker of the Ifunny channel in the sinoatrial node, on heart rate, quality of life (QOL), and plasma norepinephrine (NE) levels in patients with hyperadrenergic POTS defined by plasma NE >600 pg/ml and abnormal tilt table test.
Overall, 22 patients with hyperadrenergic POTS as the predominant subtype completed a randomized, double-blinded, placebo-controlled, crossover trial with ivabradine. Participants, more than 95% women, mostly white and with an average age of 33.9, were randomized to start either ivabradine or placebo for 1 month, and then were crossed over to the other treatment for 1 month. Researchers measured heart rate, QOL, and plasma NE levels at baseline and at the end of each treatment month.
Results indicate a significant reduction in heart rate between placebo and ivabradine (p < 0.001), according to the authors. Researchers note that patients reported significant improvements in QOL with RAND 36-Item Health Survey 1.0 for physical functioning (p = 0.008) and social functioning (p = 0.021).
“There was a strong trend in reduction of NE levels upon standing with ivabradine (p = 0.056),” the study explains. “Patients did not experience any significant side-effects, such as bradycardia or hypotension, with ivabradine.”
“Ivabradine is safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS as the predominant subtype,” researchers conclude.
"Before the study, these patients would be living with elevated heart rates ranging between 100 to 115 beats per minute when standing," Taub added. "After taking ivabradine twice a day for one month, the standing heart rate decreased significantly to around 77 beats per minute compared to the placebo group. Participants also reported improvement in quality of life measures when on the drug."
The results are especially significant with POTs being identified as a longer term side effect of COVID-19 infection. "In our contemporary practice, we are seeing patients who have previously been infected with COVID-19 present with symptoms consistent with POTS," said co-author Jonathan Hsu, MD, cardiologist at UC San Diego Health. "Given the similarities, this study leads to the question whether therapy with ivabradine may help patients who experience similar symptoms after a COVID-19 infection and provide an important area for future study as well."