SHIFT trial - Summary & Results

http://www.theheart.org/web_slides/1425587.do

A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines

1. SHIFT (Systolic Heart Failure Treatment
with the I
f Inhibitor Ivabradine Trial)

2. •Background:
Ivabradine is a selective inhibitor of a sodium-potassium channel highly
expressed in the sinoatrial node, on which it has a mild dampening effect
•Population and treatment:
>6500 patients with NYHA class 2–4 heart failure, an LVEF <35%, a resting
heart rate >70 bpm, and HF hospitalization within the previous year
Randomized to placebo or ivabradine at a starting dose of 5 mg twice daily,
with adjustments to achieve a resting HR of 50 to 60 bpm; all patients were on
standard HF medications according to guidelines
•Primary outcome:
Composite of CV death or HF hospitalization
M Komajda (Groupe Hospitalier Pitié-Salpêtrière, Paris, France)
European Society of Cardiology 2010 Congress
SHIFT (Systolic Heart Failure Treatment with the I
f
Inhibitor Ivabradine Trial)
HR=heart rate

3. Primary and secondary end points
a
•Significant 18% reduction in HR for CV death or hospitalization for worsening HF
with ivabradine vs control group—driven by significant 26% HR reductions for the
individual secondary end points of death from HF and hospitalization for
worsening HF
SHIFT: Results
Outcomes Ivabradine
(n=3241), %
Placebo
(n=3264), %
HR (95% CI) p
Primary end point 24 29 0.82 (0.75–0.90) <0.001
Death from HF 3 5 0.74 (0.58–0.94) 0.014
HF hospitalization 16 21 0.74 (0.66–0.83) <0.001
CV death, HF hospitalization, or admission for
nonfatal MI
25 30 0.82 (0.74–0.89) <0.001
a.Mean follow-up of 23 months
b.HR=hazard ratio

4. SHIFT: Commentary*
*All comments from SHIFT: Adding HR-slowing agent ivabradine to HF meds cuts mortality,
hospitalization (http://www.theheart.org/article/1113617.do)

"SHIFT confirms the importance of heart rate in the pathophysiology of heart failure
and supports the concept that reduction of heart rate contributes significantly to
beneficial outcomes in patients with heart failure. It appears therefore likely that
heart rate is not only a risk factor but may well be a mediator of the progression of
heart failure."

- Dr Inder Anand


"This is a very interesting study that tests a novel concept of heart-rate slowing as
adjunctive therapy for heart failure, but sufficient questions remain regarding whom
it is who would benefit most from this approach."

- Dr Clyde Yancy

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