Heart-rate reduction important in chronic heart failure

January 01, 0001

Heart-rate reduction important in chronic heart failure

Chronic heart failure is associated with high mortality and morbidity. Raised resting heart rate is a risk factor for adverse outcomes. The researchers from Sweden, France, Germany, the USA, the UK and Italy aimed to assess the effect of heart-rate reduction by the selective sinus-node inhibitor ivabradine on outcomes in heart failure. Patients were eligible for participation in this randomised, double-blind, placebo- controlled, parallel-group study if they had symptomatic heart failure and a left-ventricular ejection fraction of 35% or lower, were in sinus rhythm with heart rate 70 beats per min or higher, had been admitted to hospital for heart failure within the previous year, and were on stable background treatment including a â blocker if tolerated. Patients (n=6558) were randomly assigned by computer-generated allocation schedule to ivabradine titrated to a maximum of 7.5 mg twice daily or matching placebo. Patients and investigators were masked to treatment allocation. Median follow-up was 22.9 months.

24% ofpatients in the ivabradine group and 29% of those taking placebo had a primary endpoint event (significant). The effects were driven mainly by hospital admissions for worsening heart failure and deaths due to heart failure. Fewer serious adverse events occurred in the ivabradine group than in the placebo group (significant). 5% of ivabradine patients had symptomatic bradycardia compared with 1% of the placebo group (significant). Visual side-effects (phosphenes) were reported by 3% of patients on ivabradine and 1% on placebo (significant).

The researchers concluded: "Our results support the importance of heart-rate reduction with ivabradine for improvement of clinical outcomes in heart failure and confirm the important role of heart rate in the pathophysiology of this disorder."

Further possible help for a condition with a terrible prognosis.

For the full abstract, click here.

The Lancet 376(9744):875-885, 11 September 2010 © Elsevier Ltd 2010
Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Karl Swedberg, Michel Komajda, Michael Böhm et al. Correspondence to: Prof Karl Swedberg: [email protected]

Category: K. Circulatory. Keywords: Ivabradine, chronic heart failure, randomised, double- blind, placebo-controlled, parallel-group study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.