Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
Michael BöhmLuigi Tavazzi

Abstract

We analysed the effect of ivabradine on outcomes in heart failure (HF) patients on recommended background therapies with heart rates ≥75 bpm and <75 bpm in the SHIFT trial. A cut-off value of ≥75 bpm was chosen by the EMEA for approval for the use of ivabradine in chronic heart failure. The SHIFT population was divided by baseline heart rate ≥75 or <75 bpm. The effect of ivabradine was analysed for primary composite endpoint (cardiovascular death or HF hospitalization) and other endpoints. In the ≥75 bpm group, ivabradine reduced primary endpoint (HR 0.76, 95 % CI 0.68-0.85, P < 0.0001), all-cause mortality (HR 0.83, 95 % CI, 0.72-0.96, P = 0.0109), cardiovascular mortality (HR 0.83, 95 % CI, (0.71-0.97, P = 0.0166), HF death (HR 0.61, 95 % CI, 0.46-0.81, P < 0.0006), and HF hospitalization (HR 0.70, 95 % CI, 0.61-0.80, P < 0.0001). Risk reduction depended on heart rate after 28 days, with the best protection for heart rates <60 bpm or reductions >10 bpm. None of the endpoints was significantly reduced in the <75 bpm group, though there were trends for risk reductions in HF death and hospitalization for heart rate <60 bpm and reductions >10 bpm. Ivabradine was tolerated similarly in both groups. The effect of ivabradine on outc...Continue Reading

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Citations

Apr 13, 2013·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Peter DollinerGuenter Steurer
Sep 3, 2013·Heart·Andrew L Clark
Mar 8, 2013·Future Cardiology·Rashmi U Hottigoudar, Rakesh Gopinathannair
Feb 19, 2014·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Ulrich Fischer-RasokatIoakim Spyridopoulos
Feb 19, 2014·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Ulrich TebbeMichael Böhm
Oct 16, 2012·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Vincenzo De SantisLuigi Tritapepe
Feb 22, 2016·The Nursing Clinics of North America·Sheila Melander, Stephen Miller
Aug 19, 2014·International Journal of Cardiology·Romain GalletPascal Lim
Jan 30, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Tetsu Watanabe
Dec 18, 2013·The American Journal of Cardiology·Jeffrey S BorerUNKNOWN SHIFT Investigators
Jan 25, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Florian CustodisStefan Möhlenkamp
Sep 24, 2013·Heart Failure Clinics·John G F ClelandBenjamin Dicken
Jan 15, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Hiroyuki TsutsuiUNKNOWN study investigators
Mar 10, 2016·European Journal of Heart Failure·Michael BöhmMichel Komajda
Jun 1, 2015·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Arash HaghikiaDenise Hilfiker-Kleiner
Mar 20, 2014·European Journal of Heart Failure·Michael BöhmFelix Mahfoud
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Mar 13, 2014·Journal of the American College of Cardiology·Andrew P AmbrosyMihai Gheorghiade
Nov 7, 2014·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Olaf OldenburgDieter Horstkotte
Nov 11, 2015·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Marc N HirtThomas Eschenhagen
Dec 3, 2014·The American Journal of Medicine·Michael BöhmJeffrey S Borer
Jun 24, 2014·JACC. Heart Failure·Damien CullingtonAndrew L Clark
Dec 3, 2015·Journal of Clinical Pharmacology·Elaine NguyenC Michael White
Sep 1, 2016·Journal of Managed Care & Specialty Pharmacy·Jeffrey S BorerAdrian Kielhorn
Oct 27, 2016·The American Journal of Cardiology·Jeffrey S BorerMichael Böhm
Dec 29, 2016·The Journal of Physiological Sciences : JPS·Anran WangDingchang Zheng

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