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Ivabradine reduces HF readmissions during ‘vulnerable period’

Heart Failure 2016 Congress News

Michel Komajda (Hospital Pitie-Salpetriere, University Pierre & Marie Curie Paris, France)

Rapid Fire 3 - Chronic heart failure management; 23 May, 08:30–10:00; Agora



Heart failure patients treated with the heart rate slowing agent ivabradine have a significantly reduced risk of being readmitted to hospital during the high-risk ‘vulnerable period’ just after discharge, an analysis of trial data presented yesterday indicate.

The Systolic Heart Failure treatment with the If inhibitor ivabradine Trial (SHIFT) trial of more than 6500 heart failure patients showed that the selective sinus-node inhibitor ivabradine significantly reduced all rehospitalisations versus placebo, at a hazard ratio of 0.74 (p<0.0001).[1]

However, rates of readmission are particularly high soon after discharge, at approximately 15% at 1 month and 30% at 3 months post-discharge. For Michel Komajda (Hospital Pitie-Salpetriere, University Pierre & Marie Curie Paris, France), who presented the current analysis, this so-called vulnerable period represents a “major clinical issue”.

To determine whether ivabradine has an impact on hospitalisations just after discharge, Prof. Komajda and colleagues conducted a post-hoc analysis of the SHIFT data, looking specifically at all-cause hospitalisations up to 3 months after initial hospitalisation for worsening heart failure.

During the 3-month post-discharge period, 1186 patients were readmitted to hospital, at an overall rate of 28%. The rate of rehospitalisation was lower among patients treated with ivabradine than those given placebo, at 25% versus 30%.

Adjusting for prognostic factors, the team found that the difference between the two groups was significant, at a hazard ratio of 0.79 (p=0.04). The impact of ivabradine on rehospitalisation rates was particularly noticeable 1 month following hospital discharge, at a hazard ratio of 0.70 (p<0.05).

As that the patients in the SHIFT trial were all receiving guideline-recommended therapy, would Prof. Kamajda expect to see an even greater effect of ivabradine in the ‘real world’? Although this would require registry data to show it, he believes it is likely.

He told Heart Failure Congress News: “What happens in real-life situations is that you have a rather low rate or prescription of recommended therapies on the one hand, and on the other hand under-titration of these drugs.”

Patients may therefore be discharged without being on the optimal dose of recommended therapies, and end up in a “vacuum”. Prof. Komajda observed: “This probably is one of the major explanations why there is such a huge rate of early rehospitalisation after discharge from a heart failure hospitalisation.”

References

  1. Swedberg K, Komajda M, Böhm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376: 875–885.

View the session programme and access the resources on SP&P