title: Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT Study.
abstract: OBJECTIVE
  We explored the effect of treatment with ivabradine, a pure heart rate-slowing agent, on recurrent hospitalizations for worsening heart failure (HF) in the SHIFT trial.
  
  
  RESULTS
  SHIFT was a double-blind clinical trial in which 6505 patients with moderate-to-severe HF and left ventricular systolic dysfunction, all of whom had been hospitalized for HF during the preceding year, were randomized to ivabradine or to placebo on a background of guideline-recommended HF therapy (including maximized β-blockade). In total, 1186 patients experienced at least one additional HF hospitalization during the study, 472 suffered at least two, and 218 suffered at least 3. Patients with additional HF hospitalizations had more severe disease than those without. Ivabradine was associated with fewer total HF hospitalizations [902 vs. 1211 events with placebo; incidence rate ratio, 0.75, 95% confidence interval (CI), 0.65-0.87, P = 0.0002] during the 22.9-month median follow-up. Ivabradine-treated patients evidenced lower risk for a second or third additional HF hospitalization [hazard ratio (HR): 0.66, 95% CI, 0.55-0.79, P < 0.001 and HR: 0.71, 95% CI, 0.54-0.93, P = 0.012, respectively]. Similar observations were made for all-cause and cardiovascular hospitalizations.
  
  
  CONCLUSIONS
  Treatment with ivabradine, on a background of guidelines-based HF therapy, is associated with a substantial reduction in the likelihood of recurrent hospitalizations for worsening HF. This benefit can be expected to improve the quality of life and to substantially reduce health-care costs.
authors.affiliation: Department of Medicine, State University of New York Downstate Medical Center, Brooklyn and New York, NY 10128-1152, USA. canadad45@aol.com
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Borer
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Jose Lopez
authors.initials: JL
authors.lastname: Sendon
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Esteban
authors.initials: E
authors.lastname: Lopez-de-Sa
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
mesh_terms: D001552:Benzazepines / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D001552:Benzazepines; D002316:Cardiotonic Agents; D000077550:Ivabradine