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SHIFT trial - Summary & Results

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http://www.theheart.org/web_slides/1425587.do

A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines

Published in: Health & Medicine
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SHIFT trial - Summary & Results

  1. 1. SHIFT (Systolic Heart Failure Treatmentwith the If Inhibitor Ivabradine Trial)
  2. 2. SHIFT (Systolic Heart Failure Treatment with the IfInhibitor Ivabradine Trial)M Komajda (Groupe Hospitalier Pitié-Salpêtrière, Paris, France)European Society of Cardiology 2010 Congress• Background: Ivabradine is a selective inhibitor of a sodium-potassium channel highly expressed in the sinoatrial node, on which it has a mild dampening effect• Population and treatment: >6500 patients with NYHA class 2–4 heart failure, an LVEF <35%, a resting heart rate >70 bpm, and HF hospitalization within the previous year Randomized to placebo or ivabradine at a starting dose of 5 mg twice daily, with adjustments to achieve a resting HR of 50 to 60 bpm; all patients were on standard HF medications according to guidelines• Primary outcome: Composite of CV death or HF hospitalization HR=heart rate
  3. 3. SHIFT: Results• Significant 18% reduction in HR for CV death or hospitalization for worsening HF with ivabradine vs control group—driven by significant 26% HR reductions for the individual secondary end points of death from HF and hospitalization for worsening HFPrimary and secondary end pointsaOutcomes Ivabradine Placebo HR (95% CI) p (n=3241), % (n=3264), %Primary end point 24 29 0.82 (0.75–0.90) <0.001Death from HF 3 5 0.74 (0.58–0.94) 0.014HF hospitalization 16 21 0.74 (0.66–0.83) <0.001CV death, HF hospitalization, or admission for 25 30 0.82 (0.74–0.89) <0.001nonfatal MI a. Mean follow-up of 23 months b. HR=hazard ratio
  4. 4. SHIFT: Commentary*"SHIFT confirms the importance of heart rate in the pathophysiology of heart failureand supports the concept that reduction of heart rate contributes significantly tobeneficial outcomes in patients with heart failure. It appears therefore likely thatheart rate is not only a risk factor but may well be a mediator of the progression ofheart failure." - Dr Inder Anand"This is a very interesting study that tests a novel concept of heart-rate slowing asadjunctive therapy for heart failure, but sufficient questions remain regarding whomit is who would benefit most from this approach." - Dr Clyde Yancy *All comments from SHIFT: Adding HR-slowing agent ivabradine to HF meds cuts mortality, hospitalization (http://www.theheart.org/article/1113617.do)
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