Efficacy Profile of Ivabradine in Patients with Heart Failure plus Angina Pectoris.
OBJECTIVE
In the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT), slowing of the heart rate with ivabradine reduced cardiovascular death or heart failure hospitalizations among patients with systolic chronic heart failure (CHF). Subsequently, in the Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease (SIGNIFY) slowing of the heart rate in patients without CHF provided no benefit for cardiovascular death or nonfatal myocardial infarction (primary composite end point), with secondary analyses suggesting possible harm in the angina subgroup. Therefore, we examined the impact of ivabradine in the patients with CHF plus angina in SHIFT.


METHODS
SHIFT enrolled adults with stable, symptomatic CHF, a left ventricular ejection fraction ≤35% and a sinus rhythm with a resting heart rate ≥70 bpm. Outcomes were the SHIFT and SIGNIFY primary composite end points and their components.


RESULTS
Of 6,505 patients in SHIFT, 2,220 (34%) reported angina at randomization. Ivabradine numerically, but not significantly, reduced the SIGNIFY primary composite end point by 8, 11 and 11% in the SHIFT angina subgroup, nonangina subgroup and overall population, respectively. Ivabradine also reduced the SHIFT primary composite end point in all 3 subgroups.


CONCLUSIONS
In SHIFT, ivabradine showed consistent reduction of cardiovascular outcomes in patients with CHF; similar results were seen in the subgroup of SHIFT patients with angina.
The Howard Gilman Institute for Heart Valve Diseases and Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center, Brooklyn and New York, N.Y., USA.
Jeffrey S
JS
Borer
Karl
K
Swedberg
Michel
M
Komajda
Ian
I
Ford
Luigi
L
Tavazzi
Michael
M
Böhm
Christophe
C
Depre
Yuna
Y
Wu
Juan
J
Maya
Fabienne
F
Dominjon
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy*; D001552:Benzazepines / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume
D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine