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Published on: December 11, 2017

Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study

Karl Swedberg1, Michel Komajda, Michael Böhm

  • 1Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. karl.swedberg@gu.se

Lancet (London, England)
|August 31, 2010
PubMed

Insights

Heart rate reduction using ivabradine significantly improved clinical outcomes in patients with chronic heart failure. This study confirms the role of heart rate in heart failure pathophysiology, reducing cardiovascular death and hospitalizations.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Chronic heart failure presents significant mortality and morbidity.
  • Elevated resting heart rate is a known risk factor for adverse outcomes in heart failure patients.
  • The selective sinus-node inhibitor ivabradine targets heart rate reduction.

Purpose of the Study:

  • To evaluate the impact of heart rate reduction with ivabradine on clinical outcomes in patients with symptomatic heart failure.
  • To assess the efficacy of ivabradine in reducing cardiovascular death and hospital admissions for heart failure worsening.
  • To confirm the role of heart rate in the pathophysiology of heart failure.

Main Methods:

  • A randomized, double-blind, placebo-controlled, parallel-group study.
  • Inclusion criteria: symptomatic heart failure, LVEF ≤35%, sinus rhythm with HR ≥70 bpm, recent hospitalization for heart failure, and stable background treatment.
  • Patients received ivabradine titrated to 7.5 mg BID or placebo; primary endpoint was composite of cardiovascular death or heart failure hospitalization.

Main Results:

  • 6558 patients were randomized (3268 ivabradine, 3290 placebo) with median follow-up of 22.9 months.
  • Ivabradine significantly reduced the primary endpoint events by 18% (HR 0.82, p<0.0001), mainly driven by reduced hospital admissions for worsening heart failure and heart failure deaths.
  • Adverse events: symptomatic bradycardia (5% ivabradine vs 1% placebo) and visual disturbances (3% ivabradine vs 1% placebo) were more frequent with ivabradine.

Conclusions:

  • Heart rate reduction with ivabradine improves clinical outcomes in heart failure patients.
  • The study underscores the critical role of heart rate in heart failure pathophysiology.
  • Ivabradine is an effective treatment option for selected heart failure patients to reduce adverse events.
Abstract

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