analysis from the SHIFT study

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Presentation transcript:

analysis from the SHIFT study Systolic Heart failure treatment with the If inhibitor ivabradine Trial Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study Effect of ivabradine on outcomes in patients with chronic heart failure and HR 75 bpm Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Aim To assess the effect of ivabradine on outcomes in heart failure patients on recommended background therapies with heart rates ≥75 bpm in the SHIFT trial Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Baseline characteristics Ivabradine n=2052 Placebo n=2098 Mean age, years 60 Male, % 77 BMI, kg/m2 28 Mean HF duration, years 3.4 HF ischemic cause, % 66 65 NYHA class III, % 50 51 NYHA class IV, % 2 Mean LVEF, % 28.7 28.5 Mean HR, bpm 84.3 84.6 Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Baseline background treatment Ivabradine n=2052 Placebo n=2098 β-Blockers, % 87 88 At least half target dose 55 56 At target dose 26 ACE inhibitors/ARBs, % 90 Diuretics (excludes AAs), % 85 83 Aldosterone antagonists, % 63 61 Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Effect of ivabradine on primary outcome CV death or hospitalization for HF 6 12 18 24 30 40 10 Hazard ratio=0.76 P<0.0001 Patients with primary composite end point (%) Time (months) 20 Placebo Ivabradine Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

on cardiovascular death Effect of ivabradine on cardiovascular death Hazard ratio=0.83 P=0.0166 6 12 18 24 30 10 20 Time (months) Placebo Patients with cardiovascular death (%) Ivabradine Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Effect of ivabradine on hospital admission for worsening heart failure Hazard ratio=0.70 P<0.0001 Placebo 30 20 Ivabradine Patients with cardiovascular death (%) 10 6 12 18 24 30 Time (months) Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Effect of ivabradine on major outcomes 1.00 Primary composite end point Cardiovascular mortality Hospitalization for worsening HF Death from HF All-cause mortality All-cause hospitalization Any cardiovascular hospitalization 0.76 0.68-0.85 0.83 0.71-0.97 0.70 0.61-0.80 0.61 0.46-0.81 0.83 0.72-0.96 0.82 0.75-0.90 0.79 0.71-0.88 0.20 <0.0001 0.0166 0.0006 0.0109 P Hazard ratio 1.20 0.40 0.60 0.80 95% CI Favors ivabradine Favors placebo Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Effect of ivabradine on outcomes according to HR achieved at 28 days 6 12 18 24 40 10 Time (months) 20 30 Patients with primary composite end point (%) Day 28  75 bpm 70 to <75 bpm 65 to <70 bpm 60 to <65 bpm <60 bpm Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Effect of ivabradine on outcomes Patients with primary composite end point (%) Effect of ivabradine on outcomes according to magnitude of HR reduction 40  0 bpm -10 to <0 bpm < -10 bpm 30 20 10 Day 28 6 12 18 24 Time (months) Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com

Conclusions In HF in sinus rhythm with HR ≥75 bpm heart rate reduction with ivabradine improves outcomes, including all-cause death and cardiovascular death reduces Ivabradine-associated risk reductions are related to both HR achieved and magnitude of HR reduction Patients achieving <60 bpm or with >10 bpm reduction have the best prognosis Böhm M, Borer J, Ford I, et al. Clin Res Cardiol. 2013;102(1):11-22 www.shift-study.com