Efficacy Profile of Ivabradine in Patients with Heart Failure plus Angina Pectoris
Jeffrey S Borer1, Karl Swedberg, Michel Komajda
1The Howard Gilman Institute for Heart Valve Diseases and Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center, Brooklyn and New York, N.Y., USA.
Insights
Ivabradine effectively reduced cardiovascular events in patients with chronic heart failure (CHF). This benefit was consistent even in patients with CHF who also experienced angina.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT) demonstrated ivabradine's efficacy in reducing cardiovascular events in chronic heart failure (CHF) patients.
- The Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease (SIGNIFY) showed no benefit and potential harm in patients without CHF, particularly those with angina.
Purpose of the Study:
- To investigate the specific impact of ivabradine on cardiovascular outcomes in patients with CHF who also have angina, using data from the SHIFT trial.
Main Methods:
- Analysis of patients enrolled in the SHIFT trial who had stable, symptomatic CHF, left ventricular ejection fraction ≤35%, sinus rhythm, and resting heart rate ≥70 bpm.
- Evaluation of outcomes including the SHIFT and SIGNIFY primary composite endpoints and their individual components.
Main Results:
- Out of 6,505 SHIFT patients, 2,220 (34%) had angina. Ivabradine showed a numerical, though not statistically significant, reduction in the SIGNIFY primary composite endpoint in the angina subgroup.
- Ivabradine consistently reduced the SHIFT primary composite endpoint across all subgroups, including those with and without angina.
Conclusions:
- Ivabradine demonstrated a consistent reduction in cardiovascular outcomes for patients with CHF in the SHIFT trial.
- These positive results were mirrored in the subgroup of SHIFT patients who experienced angina, suggesting its benefit in this specific population.
Objectives:
In the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT), slowing of the heart rate with ivabradine reduced cardiovascular death or heart failure hospitalizations among patients with systolic chronic heart failure (CHF). Subsequently, in the Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease (SIGNIFY) slowing of the heart rate in patients without CHF provided no benefit for cardiovascular death or nonfatal myocardial infarction (primary composite end point), with secondary analyses suggesting possible harm in the angina subgroup. Therefore, we examined the impact of ivabradine in the patients with CHF plus angina in SHIFT.
Methods:
SHIFT enrolled adults with stable, symptomatic CHF, a left ventricular ejection fraction ≤35% and a sinus rhythm with a resting heart rate ≥70 bpm. Outcomes were the SHIFT and SIGNIFY primary composite end points and their components.
Results:
Of 6,505 patients in SHIFT, 2,220 (34%) reported angina at randomization. Ivabradine numerically, but not significantly, reduced the SIGNIFY primary composite end point by 8, 11 and 11% in the SHIFT angina subgroup, nonangina subgroup and overall population, respectively. Ivabradine also reduced the SHIFT primary composite end point in all 3 subgroups.
Conclusions:
In SHIFT, ivabradine showed consistent reduction of cardiovascular outcomes in patients with CHF; similar results were seen in the subgroup of SHIFT patients with angina.
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