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S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial. Main results. www.shift-study.com. Swedberg K, et al. Lancet . 2010;376(9744):875-885. Primary composite endpoint (CV death or hospital admission for worsening HF). Cumulative frequency (%). 40.
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Systolic Heart failure treatment withthe Ifinhibitor ivabradineTrial Main results www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Primary composite endpoint(CV death or hospital admission for worsening HF) Cumulative frequency (%) 40 HR = 0.82 (0.75–0.90) P < 0.0001 Placebo 18% 30 Ivabradine 20 10 0 0 6 12 18 24 30 Months www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Hospitalization for HF Cumulative frequency (%) 30 Placebo HR =0.74 (0.66–0.83) P < 0.0001 26% 20 Ivabradine 10 0 0 6 12 18 24 30 Months www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Death from heart failure Cumulative frequency (%) 10 HR = 0.74 (0.58–0.94) P = 0.014 Placebo 26% 5 Ivabradine 0 0 6 12 18 24 30 Months www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Effect of ivabradineon outcomes www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Effect of ivabradine in prespecified subgroups Test for interaction Age<65 years≥65 years Sex Male Female Beta-blockers No Yes Aetiology of heartfailure Non-ischaemic Ischaemic NYHA class NYHA class II NYHA class III or IV Diabetes No Yes Hypertension No Yes Baseline heart rate <77 bpm ≥77 bpm P = 0.029 0.5 1.0 1.5 Hazard ratio Favours ivabradine Favours placebo www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Mean heart rate reduction 70% of patients on ivabradine 7.5 mg bid Heart rate (bpm) 90 80 80 Placebo 75 75 70 67 Ivabradine 64 60 50 0 2 weeks 1 4 8 12 16 20 24 28 32 Months www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Ivabradine Placebo NYHA class changes Patients (%) 70 68 P = 0.0003 70 60 50 40 28 24 30 20 6 5 10 0 Improvement Stability Worsening www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Incidence of selected adverse events (n = 6492) www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Treatment discontinuation www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885
Conclusion Ivabradine significantly reduces major risks associated with heart failure: • 18% reduction in CV death or hospital admission for worsening HF • 26% reduction in death from heart failure • 26% reduction in hospital admission for worsening heart failure Benefits are apparent early, are consistent in predefined subgroups, and have been demonstrated on top of recommended therapy Treatment is well tolerated www.shift-study.com Swedberg K, et al. Lancet. 2010;376(9744):875-885