Efficacy of ivabradine in heart failure patients with a high‐risk profile (analysis from the SHIFT trial) - Université Claude Bernard Lyon 1 Accéder directement au contenu
Article Dans Une Revue ESC Heart Failure Année : 2023

Efficacy of ivabradine in heart failure patients with a high‐risk profile (analysis from the SHIFT trial)

Amr Abdin
  • Fonction : Auteur
  • PersonId : 1354805
Michel Komajda
  • Fonction : Auteur
Jeffrey S Borer
  • Fonction : Auteur
Ian Ford
  • Fonction : Auteur
Luigi Tavazzi
  • Fonction : Auteur
Karl Swedberg
  • Fonction : Auteur
Giuseppe M.C. Rosano
  • Fonction : Auteur
Felix Mahfoud
  • Fonction : Auteur
Michael Böhm
  • Fonction : Auteur

Résumé

Abstract Aims Early start and patient profile‐oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP) < 110 mmHg, resting heart rate (RHR) ≥ 75 b.p.m., left ventricular ejection fraction (LVEF) ≤ 25%, New York Heart Association (NYHA) Class III/IV, and their combination. Methods and results The SHIFT trial enrolled 6505 patients (LVEF ≤ 35% and RHR ≥ 70 b.p.m.), randomized to ivabradine or placebo on the background of guideline‐defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP < 110 and ≥110 mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74–1.08 vs. HR 0.80, 95% CI 0.72–0.89, P interaction = 0.34], LVEF ≤ 25% and >25% (HR 0.85, 95% CI 0.72–1.01 vs. HR 0.80, 95% CI 0.71–0.90, P interaction = 0.53), and NYHA III–IV and II (HR 0.83, 95% CI 0.74–0.94 vs. HR 0.81, 95% CI 0.69–0.94, P interaction = 0.79). The effect was more pronounced in patients with RHR ≥ 75 compared with <75 (HR 0.76, 95% CI 0.68–0.85 vs. HR 0.97, 95% CI 0.81–0.1.16, P interaction = 0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low‐risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. Conclusions Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern.
Fichier principal
Vignette du fichier
Abdin et al. - 2023 - Efficacy of ivabradine in heart failure patients w.pdf (755.53 Ko) Télécharger le fichier
Origine Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-04468611 , version 1 (20-02-2024)

Identifiants

Citer

Amr Abdin, Michel Komajda, Jeffrey S Borer, Ian Ford, Luigi Tavazzi, et al.. Efficacy of ivabradine in heart failure patients with a high‐risk profile (analysis from the SHIFT trial). ESC Heart Failure, 2023, 10 (5), pp.2895-2902. ⟨10.1002/ehf2.14455⟩. ⟨hal-04468611⟩
6 Consultations
4 Téléchargements

Altmetric

Partager

Gmail Mastodon Facebook X LinkedIn More