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SHIFT: Relationship between heart rate and health related quality of life. Results from SHIFT

Heart Failure (HF)

Presenter | see Discussant report

Inger Ekman, NFESC Inger Ekman (Sweden)

Presentation webcast

Presentation slides

List of Authors:
Inger Ekman, Olivier Chassany, Michel Komajda, Michael Böhm, Jeffrey S. Borer, Ian Ford, Luigi Tavazzi, and Karl Swedberg on behalf of the SHIFT Investigators.


Heart failure (HF) has a major impact on health-related quality of life (HQoL). The aim was to evaluate whether heart rate (HR) reduction with ivabradine can translate into increased HQoL in parallel to a reduction of primary outcomes in SHIFT.

Methods: In symptomatic patients with systolic HF treated with recommended background therapy, HQoL was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) containing the following dimensions: overall summary score (OSS) and clinical summary score (CSS), analysed at baseline, and 4, 12, and 24 months, and last post-baseline visit. A total of 1944 patients (968 ivabradine, 976 placebo) were evaluated.

Results: At 12 months, incidence of clinical events (cardiovascular death or hospital admission for HF) was inversely associated with KCCQ scores. Ivabradine reduced HR by 10.1 bpm (placebo-corrected, P< 0.001) and improved KCCQ by 1.8 for CSS and 2.4 for OSS (placebo-corrected, P< 0.02 and P<0.01, respectively); these changes were associated with the change in HR for both CSS (P<0.001) and OSS (P<0.001). The relationship was found in both allocation groups though the changes were more pronounced in the ivabradine group. Health-related quality of life at follow-up was better preserved in the ivabradine group compared with placebo; poorest outcomes were seen in the placebo group with lowest KCCQ scores (<,50).

Conclusion: In patients with systolic HF, low HQoL is associated with an increased rate of cardiovascular death or hospital admission for HF. Reduction in HR with ivabradine is associated with improved HQoL.

Discussant | see Presenter abstract

Erland Erdmann (Germany)

Presentation webcast

Presentation slides


Relationship between heart rate and health related quality of life.
Main findings: The importance of heart-rate reduction with ivabradine for improvement of clinical outcomes has been shown in the SHIFT trial. This further analysis of the SHIFT trial has clearly demonstrated in systolic heart failure that the observed heart rate reduction is also associated with an increased health related quality of life self assessment. This has confirmed the important role of reducing heart rate in CHF.

Strength of the study: The number of patients evaluated (1944) was large enough to allow generalisation of the data. The Kansas City Cardiomyopathy Questionnaire (KCCQ), which has been used, is a new, self- administered, 23-item questionnaire that quantifies physical limitations, symptoms, self-efficacy, social interference and quality of life. Its sensitivity is substantially greater than other questionaires.

Limitations of the study: In the past years, betablocker treatment of CHF has not been shown to improve quality of life. However, in these betablocker trials heart rate has not been titrated down in the same way as in the SHIFT trial. Thus, there remains the possibility that downtitration of heart rate – whether with ivabradine or with betablockers – both would alleviate patient suffering and improve HQoL.

Conclusions: When treating CHF patients, we should try to achieve heart rates in the range of 50 – 60 beats per minute in order to prolong life and to improve self felt quality of life.


710007 - 710008


Clinical Trial Update II - Rate and rhythm

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.