Dr. Stefan Anker,
Dr. Jeffrey Stephen Borer
Presenter: Jeffrey Stephen Borer | see Discussant report
List of Authors: Jeffrey S Borer,1 Michael Böhm,2 Ian Ford,3 Michel Komajda,4 Luigi Tavazzi,5, Jose Lopez Sendon,6 Marco Alings,7 Esteban Lopez-de-Sa,6 and Karl Swedberg,8on behalf of the SHIFT Investigators
Aims:We explored the effect of treatment with ivabradine, a pure heart rate–slowing agent, on recurrent hospitalizations for worsening heart failure (HF) in the SHIFT trial.
Methods and results:SHIFT was a double-blind clinical trial in which 6505 patients with moderate-to-severe HF and left ventricular systolic dysfunction, all of whom had been hospitalized for HF during the preceding year, were randomized to ivabradine or to placebo on a background of guideline recommended HF therapy (including maximized beta-blockade). In total, 1186 patients experienced at least one additional HF hospitalization during the study, 472 suffered at least two, and 218 suffered at least three. Patients with additional HF hospitalizations had more severe disease than those without. Ivabradine was associated with fewer total HF hospitalizations (902 events versus 1211 events with placebo; incidence rate ratio, 0.75, 95% CI, 0.65 to 0.87, p=0.0002) during the 22.9-month median follow-up. Ivabradine-treated patients evidenced lower risk for a second or third additional HF hospitalization (HR, 0.66, 95% CI, 0.55 to 0.79, p<0.001 and HR, 0.71, 95% CI, 0.54 to 0.93, p=0.012, respectively). Similar observations were made for all-cause and cardiovascular hospitalizations.
Conclusion:Treatment with ivabradine, on a background of guidelines-based HF therapy, is associated with a substantial reduction in the likelihood of recurrent hospitalizations for worsening HF. This benefit can be expected to reduce the burden of HF for the patient and to substantially reduce health care costs.
Discussant: Stefan Anker | see Presenter abstract
710001 - 710002
Clinical Trial & Registry Update II: Updates on Heart Failure and Coronary Artery Disease
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