SHIFT: Ivabradine associated with reduced HF risk

Komajda M. Session 706005-706006.

European Society of Cardiology Congress 2010

The addition of ivabradine to standard clinical care in patients with HF was linked with a reduction in some adverse HF outcomes, results from a study showed.

Researchers for the multinational SHIFT trial enrolled 6,558 patients with NYHA Class II to IV HF and a heart rate of at least 70 beats per minute. Patients were randomly assigned to receive either ivabradine (Procoralan, Servier; n=3,268) or placebo (n=3,290) during a median study duration of 22.9 months. The primary study endpoint was a composite of CV death and hospitalization for worsening HF, with secondary endpoints of all-cause/CV/HF mortality, all-cause/CV/HF hospitalization, and a composite of CV death, hospitalization for HF and nonfatal MI. Eighty-nine percent of patients in both groups received beta-blocker treatment at baseline.

Study results indicated that there was an 18% decrease in the incidence of the combined study endpoint at 30 months in patients assigned ivabradine vs. placebo (14.5% vs. 17.7%; HR=0.82; 95% CI, 0.75-0.90). There was also a 26% reduction in the incidence of HF hospitalization in the ivabradine group vs. placebo during the same time period (9.4% vs. 12.7%; HR=0.74; 95% CI, 0.66-0.83). According to the researchers, the effects were driven primarily by hospital admissions for worsening HF and deaths attributed to HF (HR=0.74; 95% CI, 0.58-0.94).

“Overall, treatment with ivabradine was safe and well-tolerated,” Michel Komajda, MD, a professor of cardiology at University Pierre et Marie Curie and at Pitie Salpetriere Hospital in France, said in his concluding remarks. “The addition of ivabradine to recommended therapy significantly reduces death and hospitalizations related to HF in patients with heart rate >70 beats per minute.”

SHIFT confirms the importance of the heart rate in the pathophysiology of HF and supports the concept that reduction in heart rate contributes significantly to beneficial outcomes in patients with HF. Heart rate is not only a risk factor, but may well be a mediator of progression of HF. In patients with systolic HF in sinus rhythm who have a heart rate >70 beats per minute, who are receiving usual clinical care and who are unable to tolerate higher doses of beta blockers, the addition of the pure heart rate-reducing agent ivabradine is likely to improve HF outcomes.

– Inder Anand, MD

Director, Heart Failure Program

Professor of Medicine, University of Minnesota

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