SHIFT

Systolic Heart failure treatment with the If inhibitor ivabradine Trial

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 6,558 patients with HFrEF (EF ≤ 35%) in sinus rhythm with heart rate ≥ 70 bpm, ivabradine reduced cardiovascular death or hospitalisation for worsening heart failure compared with placebo.

6558

Disegno

Double-blind placebo-controlled RCT

Esito

Composite of cardiovascular death or hospitalisation for worsening heart failure

Rilevanza

Risultato24% with ivabradine vs 29% with placebo (HR 0.82, 95% CI 0.75-0.90; P<0.0001), driven mainly by fewer HF hospitalisations.

Swedberg K, et al. Lancet. 2010;376(9744):875-885. 10.1016/S0140-6736(10)61198-1

Discussione e critica

Benefit confined to sinus rhythm with heart rate ≥70 bpm, and background beta-blocker doses often submaximal. Established ivabradine for HFrEF with elevated heart rate despite maximally tolerated beta-blockade.