title: Effect of ivabradine in patients with left-ventricular systolic dysfunction: a pooled analysis of individual patient data from the BEAUTIFUL and SHIFT trials.
abstract: OBJECTIVE
  To test the effect of ivabradine on the outcomes in a broad population with left-ventricular (LV) systolic dysfunction with coronary artery disease (CAD) and/or heart failure (HF).
  
  
  RESULTS
  Individual trial data from BEAUTIFUL and SHIFT were pooled to evaluate the effect of ivabradine on the outcomes in patients with LV dysfunction and heart rate ≥ 70 b.p.m. The pooled population (n = 11 897; baseline age 62.3 ± 10.4 years, heart rate 79.6 ± 9.2 b.p.m., and LV ejection fraction 30.3 ± 5.6%) was well treated according to current recommendations (87% beta-blockers, 90% renin-angiotensin system inhibitors). Median follow-up was 21 months. Treatment with ivabradine was associated with a 13% relative risk reduction for the composite of cardiovascular mortality or HF hospitalization (P < 0.001 vs. placebo); this was driven by HF hospitalizations (19%, P < 0.001). There were also significant relative risk reductions for the composite of cardiovascular mortality, HF hospitalizations, or myocardial infarction (MI) hospitalization (15%, P < 0.001); cardiovascular mortality and non-fatal MI (10%, P = 0.023); and MI hospitalization (23%, P = 0.009). Similar results were found in patients with differing clinical profiles. Ivabradine was well tolerated.
  
  
  CONCLUSIONS
  Ivabradine may be important for the improvement of clinical outcomes in patients with LV systolic dysfunction and heart rate ≥ 70 b.p.m., whatever the primary clinical presentation (CAD or HF) or clinical status (NYHA class).
authors.affiliation: NHLI Imperial College and ICMS, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. k.fox@rbht.nhs.uk
authors.forename: Kim
authors.initials: K
authors.lastname: Fox
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Michele
authors.initials: M
authors.lastname: Robertson
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Borer
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006339:Heart Rate / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000077550:Ivabradine; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D002316:Cardiotonic Agents; D000077550:Ivabradine
keywords: BEAUTIFUL; Heart rate; Ivabradine; LV function; Prognosis; SHIFT