Slowing heart rates with ivabradine improves outcomes — and provokes questions about the optimal use of beta-blockers — in patients with heart failure.
A fast heart rate predicts adverse outcomes in patients with chronic heart failure, but is it a marker or a mediator? In SHIFT, a randomized, placebo-controlled, manufacturer-sponsored study, investigators evaluated the effects of ivabradine, a selective sinus-node inhibitor, in 6505 adults (mean age, 60; 76% men) with symptomatic heart failure, left ventricular ejection fractions ≤35%, and baseline heart rates ≥70 beats per minute (bpm). The primary endpoint was a composite of cardiovascular death and hospitalization for heart failure. Median follow-up was 22.9 months.
At baseline, mean heart rate was 80 bpm, and average systolic blood pressure was 122 mm Hg. About 90% of the participants took beta-blockers, although only 56% received at le…
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DisclosuresConsultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime
EquityHugo Health; Refactor Health; Element Science
Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association
DisclosuresConsultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime
EquityHugo Health; Refactor Health; Element Science
Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association