S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial
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Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta- blocker dose? Systolic Heart failure treatment with the I f inhibitor ivabradine Trial www.shift-study.com Swedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945
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S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial. Effects on outcomes of heart rate r eduction by i vabradine in patients w ith congestive h eart f ailure : i s there an influence of beta-blocker d ose ?. - PowerPoint PPT Presentation
Transcript of S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial
Effects on outcomes of heart rate reduction by ivabradine in patients with congestive
heart failure:
is there an influence of beta-blocker dose?
Systolic Heart failure treatment with
the If inhibitor ivabradine Trial
www.shift-study.comSwedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945
Clinical characteristics of patients by β-blocker status
No BB BB <25% of target
dose
BB 25% to <50% of target
dose
BB
50% to <100% of target dose
BB
≥100% of target dose
Age, years 64 61 60 60 58
Resting HR, bpm 84.2 80.6 79.5 79.1 78.9
Systolic BP, mm Hg 121 117 120 122 125
LV EF, % 28.7 28.1 28.9 29.4 29.3
NYHA III or IV, % 58 54 49 50 51
COPD, % 33 11 11 9 5
Asthma, % 11 2 2 2 2
PAD, % 10 6 6 6 5
Hypertension, % 63 55 63 70 73
ACE/ARB, % 90 86 90 92 93
Diuretic, % 86 87 83 83 81
Swedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945 www.shift-study.com
BB category
(% of target dose)
Placebo event rate (%)
Hazard ratio 95 % CI
PEP (CV death, HF hospitalisation)
No β-blocker 39.3 0.71 0.55-0.93
BB, 25% 40 0.74 0.59-0.92
BB, 25% to <50% 30.8 0.81 0.68-0.98
BB, 50% to <100% 24.8 0.88 0.72-1.07
BB, ≥100% 20.1 0.99 0.79-1.24
HF hospitalisation
No β-blocker 29 0.62 0.45-0.85
BB, 25% 29 0.68 0.52-0.89
BB, 25% to <50% 22 0.74 0.59-0.93
BB, 50% to <100% 18 0.83 0.65-1.05
BB, ≥100% 14 0.84 0.63-1.11**adjusted for interaction between baseline HR and randomised treatment
P
heterogeneity
0.35
0.55
P
Trend
P
Trend adj**
0.056 0.135
0.12 0.19
Effect of ivabradine on outcomes by β-blocker doses
Swedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945 www.shift-study.com
0
4
8
12
16
<72
72 to <75
75 to <80
80 to <87
≥87
No BB BB<25% BB ≥100%
β-blocker category
Baseline HR category (bpm)
HR reduction according toβ-blocker and HR category
HR reduction (bpm) from baseline to 28 days with ivabradine*
BB 25-50% BB 50-100%
*Placebo corrected
No impact of BB dose on HR reduction with ivabradine
Impact of baseline HR on HR reduction
with ivabradine
Swedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945 www.shift-study.com
• In patients with systolic HF treated with guideline-recommended therapies, resting HR remains an important modifiable risk factor in patients treated with β-blockers
• When HR ≥70 bpm, reduction of heart rate with ivabradine will provide additional clinical benefits regardless of the ß-blocker dose
• The magnitude of HR reduction with ivabradine, beyond that achieved by β-blockers, primarily determines subsequent outcome
Conclusion
Swedberg K, et al. J Am Coll Cardiol. 2012; 59:1938-1945 www.shift-study.com
