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S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial. Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study
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Systolic Heart failure treatment withthe Ifinhibitor ivabradineTrial 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. ClinRes 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 bpmin the SHIFT trial Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Baseline characteristics Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Baseline background treatment Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Effectof ivabradine on primaryoutcome CV death or hospitalization for HF Hazard ratio=0.76 P<0.0001 Placebo 40 30 Ivabradine Patientswithprimary composite end point (%) 20 10 0 0 6 12 18 24 30 Time (months) Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Effectof ivabradine on cardiovasculardeath Hazard ratio=0.83 P=0.0166 Placebo 30 Patients withcardiovasculardeath (%) 20 Ivabradine 10 0 0 6 12 18 24 30 Time (months) Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Effectofivabradine on hospitaladmission for worsening heart failure Hazard ratio=0.70 P<0.0001 Placebo 30 20 Ivabradine Patients withcardiovasculardeath (%) 10 0 0 6 12 18 24 30 Time (months) Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Effectofivabradine on majoroutcomes • 95% CI P Hazard ratio Primary composite end point Cardiovascularmortality HospitalizationforworseningHF Death from HF All-causemortality All-causehospitalization Anycardiovascularhospitalization 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 <0.0001 0.0166 <0.0001 0.0006 0.0109 <0.0001 <0.0001 0.20 0.40 0.60 0.80 1.00 1.20 Favors ivabradine Favors placebo Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Effect of ivabradine on outcomes according to HR achieved at 28 days Patients withprimary composite end point (%) 75 bpm 70 to <75 bpm 65 to <70 bpm 60 to <65 bpm <60 bpm 40 30 20 10 0 0 Day 28 6 12 18 24 Time (months) Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Patients withprimary 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 0 0 Day 28 6 12 18 24 Time (months) Böhm M, Borer J, Ford I, et al. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com
Conclusions • In HF in sinus rhythm with HR ≥75 bpmheart 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. ClinRes Cardiol. 2013;102(1):11-22 www.shift-study.com