6/29/23, 11:41 PM SHIFT Pathway Feedback Search Clinical Topics Home Studies SHIFT SHIFT Disease Heart failure Trial question What is the effect of ivabradine on heart-rate reduction in patients with chronic HF? Study design Multi-center Double blinded RCT Population Characteristics of study participants 23.2% female N = 6558 76.8% male 6558 patients (1535 female, 4970 male) Inclusion criteria: patients with symptomatic HF and a left-ventricular ejection fraction < 35% who were in sinus rhythm with HR 70 beats/min and had been admitted to hospital for HF within the previous year Key exclusion criteria: recent (< 2 months) myocardial infarction, ventricular or atrioventricular pacing operative for 40% of the day, AF or flutter, and symptomatic hypotension Interventions N=3268 ivabradine (titrated to a maximum of 7.5 mg BID) N=3290 placebo (matching placebo BID) Primary outcome https://web.pathway.md/studies/rec70ZHrZLoUIyQO3 1/2 6/29/23, 11:41 PM SHIFT Pathway Cardiovascular death or hospital admission for worsening heart failure 29.0 % 29 24 21.8 % 14.5 % Significant decrease 7.3 % NNT = 20 0.0 % Ivabradine Placebo Significant decrease in cardiovascular death or hospital admission for worsening HF (24% vs. 29%; HR 0.82, 95% CI 0.75 to 0.9) Secondary outcomes Significant decrease in hospital admission for worsening HF (21% vs. 16%; HR 0.74, 95% CI 0.66 to 0.83) Significant decrease in death due to HF (5% vs. 3%; HR 0.74, 95% CI 0.58 to 0.94) Safety outcomes Significant differences in serious adverse events (3388 vs. 3847, p = 0.025), symptomatic bradycardia (5% vs. 1%, p < 0.0001), and visual side-effects (3% vs. 1%, p < 0.0001). Conclusion In patients with symptomatic HF and a left-ventricular ejection fraction < 35% who were in sinus rhythm with HR 70 beats/min and had been admitted to hospital for HF within the previous year, ivabradine was superior to placebo with respect to cardiovascular death or hospital admission for worsening HF. Reference Swedberg K, Komajda M, Bohm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010 Sep 11;376(9744):875-85. Open reference URL https://web.pathway.md/studies/rec70ZHrZLoUIyQO3 2/2