# Ivabradine and Milrinone—Bridge to Recovery in New HFrEF With Low-Output Heart Failure

## TL;DR

This paper explores using ivabradine and milrinone to help patients with severe heart failure recover before needing major treatments like transplants.

## Contribution

The novel use of ivabradine and milrinone as a bridge to recovery in newly diagnosed HFrEF patients is highlighted.

## Key findings

- Ivabradine and milrinone helped optimize treatment and promote heart recovery in patients with severe HFrEF.
- Structural heart improvement was observed for over a year in these patients.
- The approach supported eventual reverse remodeling and improved clinical outcomes.

## Abstract

In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF) who are on a downward clinical trajectory, options are mostly limited to left ventricular assist device and transplantation. However, in those with factors favorable for reverse remodeling, every effort should be made to promote native myocardial recovery. We present three patients with newly diagnosed severe HFrEF, NYHA Class 3–4 symptoms, and low cardiac output with and without organ malperfusion. Ivabradine and/or home milrinone were used during their tenuous hemodynamic period as a bridge to optimize guideline-directed medical therapy (GDMT), device therapy, and eventual reverse remodeling. Evidence of structural heart improvement continued far beyond 1 year.