Problem CHF; EF < 35%
Format Double-blinded multi-center RCT
Treatment Ivabradine (5-7.5mg BD)
Control Placebo
Population 6558 patients
Inclusion criteria Symptomatic heart failure and a left-ventricular ejection fraction of 35% or lower
Sinus rhythm
Heart rate 70 beats per min or higher
Had been admitted to hospital for heart failure within the previous year
On stable background treatment including a Î_ blocker if tolerated
Exclusion criteria Main exclusion criteria include recent myocardial infarction, ventricular, or atrioventricular pacing that is operative for more than 40% of the day, atrial fibrillation or symptomatic hypotension.
Follow-up Median 22.9 months
Primary endpoint Composite of cardiovascular death or hospital admission for worsening heart failure
Secondary endpoint(s) Composite of CV death or admission for worsening HF in patients at >50% of the target daily dose of a Î_ blocker
Details .
Brief summary: Ivabradine reduced CCF admissions and deaths, especially those with higher HR
PAPER: Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study.
Date 11 Sep 2010
Journal Lancet. 2010 Sep 11;376(9744):875-85.
Information Ivabradine vs. placebo
-N.B. Patients all sinus, HR > 70 +- B-blocker
-Significant reduction in composite of CV death & HF admission
--Mainly due to reductions in HF admissions
---Apparent within 3 months
--NNT 26 to prevent 1/yr

-In those on >=50% target daily B-blocker dose
--Reduced HF admissions
--No reductions in mortality

-Those with >median HR had high risks of an event & more benefit
--See BEAUTIFUL trial
-More withdrawals with ivabradine, but fewer serious events than placebo