Heart failure is a condition characterized by reduced cardiac output occurring due to complications of cardiovascular disease. It is a leading cause of hospital admissions and has a poor prognosis. The 2017 Canadian Cardiovascular Society guidelines recommend that ivabradine be considered in patients with a reduced left ventricular ejection fraction (LVEF) of 40% or less. Conversely, the Canadian product monograph and the recommendation for ivabradine by CADTH’s drug expert committee specify a requirement for a LVEF of 35% or less. Therefore, the jurisdictional drug plan members asked for a review of the evidence on the ejection fraction requirement for ivabradine.