Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT Study

被引:113
|
作者
Borer, Jeffrey S. [1 ,2 ]
Boehm, Michael [3 ]
Ford, Ian [4 ]
Komajda, Michel [5 ]
Tavazzi, Luigi [6 ]
Lopez Sendon, Jose [7 ]
Alings, Marco [8 ]
Lopez-de-Sa, Esteban [7 ]
Swedberg, Karl [9 ]
机构
[1] Suny Downstate Med Ctr, Dept Med, Brooklyn, NY 10128 USA
[2] Suny Downstate Med Ctr, Dept Med, New York, NY 10128 USA
[3] Univ Saarlandes Kliniken, Innere Med Klin 3, Homburg, Germany
[4] Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland
[5] Univ Paris 06, Dept Cardiol, Hop La Pitie Salpetriere, Paris, France
[6] Ettore Sansavini Hlth Sci Fdn, Maria Cecilia Hosp GVM Care & Res, Cotignola, Italy
[7] UAM, Dept Cardiol, Hosp Univ La Paz, IdiPaz, Madrid, Spain
[8] Hosp Amphia Ziekenhuis, NL-4818 CK Breda, Netherlands
[9] Univ Gothenburg, Dept Emergency & Cardiovasc Med, Sahlgrenska Acad, Gothenburg, Sweden
关键词
Heart failure; Hospitalization; Ivabradine; Left ventricular systolic dysfunction; Heart rate; CARDIAC RESYNCHRONIZATION THERAPY; SUBSEQUENT MORTALITY; RESOURCE UTILIZATION; REDUCTION; RISK; CANDESARTAN; CARVEDILOL; DIAGNOSIS; EVENTS; TRIAL;
D O I
10.1093/eurheartj/ehs259
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We explored the effect of treatment with ivabradine, a pure heart rate-slowing agent, on recurrent hospitalizations for worsening heart failure (HF) in the SHIFT trial. SHIFT was a double-blind clinical trial in which 6505 patients with moderate-to-severe HF and left ventricular systolic dysfunction, all of whom had been hospitalized for HF during the preceding year, were randomized to ivabradine or to placebo on a background of guideline-recommended HF therapy (including maximized -blockade). In total, 1186 patients experienced at least one additional HF hospitalization during the study, 472 suffered at least two, and 218 suffered at least 3. Patients with additional HF hospitalizations had more severe disease than those without. Ivabradine was associated with fewer total HF hospitalizations [902 vs. 1211 events with placebo; incidence rate ratio, 0.75, 95 confidence interval (CI), 0.650.87, P 0.0002] during the 22.9-month median follow-up. Ivabradine-treated patients evidenced lower risk for a second or third additional HF hospitalization [hazard ratio (HR): 0.66, 95 CI, 0.550.79, P 0.001 and HR: 0.71, 95 CI, 0.540.93, P 0.012, respectively]. Similar observations were made for all-cause and cardiovascular hospitalizations. Treatment with ivabradine, on a background of guidelines-based HF therapy, is associated with a substantial reduction in the likelihood of recurrent hospitalizations for worsening HF. This benefit can be expected to improve the quality of life and to substantially reduce health-care costs.
引用
收藏
页码:2813 / 2820
页数:8
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