Heart failure & cardiomyopathies
Efficacy of Ivabradine in Heart Failure Patients with a High-Risk Profile (Analysis from the SHIFT Trial)
Authors' conclusion
Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern.
Study context
- Population
- Heart failure (HF) patients with left ventricular ejection fraction (LVEF) ≤ 35% and resting heart rate (RHR) ≥ 70 b.p.m., analysed by high-risk profile (systolic blood pressure (SBP) < 110 mmHg, RHR ≥ 75 b.p.m., LVEF ≤ 25%, New York Heart Association (NYHA) III/IV, and their combination)
- Participants
- 6,505 patients
- Comparison
- Ivabradine vs placebo on background of guideline-defined standard care
- Primary endpoint
- CV death or HF hospitalization
Methodological detailssubgroup analysis
- Subgroup analysis
Primary result
As reported in the abstract
CV death or HF hospitalization, by risk-profile subgroup
Ivabradine vs PlaceboHazard ratio (95% CI)
SBP < 110 mmHg
0.89(0.74–1.08)
SBP ≥110 mmHg
0.80(0.72–0.89)
LVEF ≤ 25%
0.85(0.72–1.01)
LVEF >25%
0.80(0.71–0.90)
NYHA III-IV
0.83(0.74–0.94)
NYHA II
0.81(0.69–0.94)
RHR ≥ 75 b.p.m.
0.76(0.68–0.85)
- Combined high-risk profile: relative risk reduction, primary endpoint
- 29%
- Combined high-risk profile: relative risk reduction, CV death
- 11%
- Combined high-risk profile: relative risk reduction, HF death
- 49%
- Combined high-risk profile: relative risk reduction, HF hospitalization
- 38%
Further findings
Combined high-risk profile
- RRR, primary endpoint
- 29%
- RRR, CV death
- 11%
- RRR, HF death
- 49%
- RRR, HF hospitalization
- 38%
- Comparable with low-risk profiles; all interaction P values: 0.40
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Efficacy of Ivabradine in Heart Failure Patients with a High-Risk Profile (Analysis from the SHIFT Trial). ESC Heart Fail. Published 10 July 2023. doi:10.
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