Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study.

摘要: Summary Background Chronic heart failure is associated with high mortality and morbidity. Raised resting rate a risk factor for adverse outcomes. We aimed to assess the effect of heart-rate reduction by selective sinus-node inhibitor ivabradine on outcomes in failure. Methods Patients were eligible participation this randomised, double-blind, placebo-controlled, parallel-group study if they had symptomatic left-ventricular ejection fraction 35% or lower, sinus rhythm 70 beats per min higher, been admitted hospital within previous year, stable background treatment including β blocker tolerated. randomly assigned computer-generated allocation schedule titrated maximum 7·5 mg twice daily matching placebo. investigators masked allocation. The primary endpoint was composite cardiovascular death admission worsening Analysis intention treat. This trial registered, number ISRCTN70429960. Findings 6558 patients groups (3268 ivabradine, 3290 placebo). Data available analysis 3241 group 3264 allocated Median follow-up 22·9 (IQR 18–28) months. 793 (24%) 937 (29%) those taking placebo event (HR 0·82, 95% CI 0·75–0·90, p vs 514 [16%] ivabradine; HR 0·74, 0·66–0·83; 113 [3%]; 0·58–0·94, p=0·014). Fewer serious events occurred (3388 events) than (3847; p=0·025). 150 (5%) bradycardia compared 32 (1%) (p Interpretation Our results support importance improvement clinical confirm important role pathophysiology disorder. Funding Servier, France.