Heart-rate reduction may improve clinical outcomes in heart failure

January 01, 0001

Heart-rate reduction may improve clinical outcomes in heart failure

Raised resting heart rate is a risk factor for adverse outcomes in patients with heart failure. The researchers from Sweden, France, Germany, USA, 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 beta-blocker if tolerated. Patients 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. Data were available for analysis for 3241 patients in the ivabradine group and 3264 patients allocated placebo. Median follow-up was 22.9 months.

24% of patients in the ivabradine group and 29% of those taking placebo had a primary endpoint event (relative risk 0.82). The effects were driven mainly by hospital admissions for worsening heart failure (21% placebo vs 16% ivabradine) and deaths due to heart failure (5% vs 3%). Fewer serious adverse events occurred in the ivabradine group (3388 events) than in the placebo group (3847). 5% of ivabradine patients had symptomatic bradycardia compared with 1% of the placebo group. Visual side-effects (phosphenes) were reported by 3% of patients on ivabradine and 1% on placebo (all given results 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."

The results of this study can't be generalized to patients who do not fit the study criteria of this study or who fit the other criteria but with a pulse rate below 70 bpm.

For the full abstract, click here.

The Lancet published online 29 August 2010 © 2010 Elsevier Ltd
Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Karl Swedberg, Michel Komajda, Michael Böhm et al on behalf of the SHIFT Investigators. Correspondence to Karl Swedberg: [email protected]

Category: K. Circulatory. Keywords: ivabradine, chronic hearet failre, outcome, SHIFT, randomised, double-blind, placebo-controlled, parallel-group study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor BLANK 2010

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