Duration of chronic heart failure affects outcomes with preserved effects of heart rate reduction with ivabradine: findings from SHIFT

Abstract

Duration of HF predicts outcome independently of risk indicators such as higher age, greater severity and more co-morbidities. Heart rate reduction with ivabradine improved outcomes independently of HF duration. Thus, HF treatments should be initiated early and it is important to characterize HF populations according to the chronicity of HF in future trials.

Considering the duration of heart failure: using the past to predict the future

“…After multivariable adjustment, the investigators found robust and statistically significant associations between increased duration of HF and heightened risk for adverse clinical outcomes. 6 These findings were consistent across all study endpoints, including cardiovascular death, all-cause death and hospitalization for HF. The investigators also confirmed consistent therapeutic efficacy of ivabradine across the range of HF duration included in the trial, with a near 20% relative risk reduction for the primary endpoint irrespective of HF chronicity.…”

“…Among the 6505 patients for whom data were available on time of HF diagnosis, baseline clinical profile differed substantially by duration of HF, with those with longer duration tending to be older with worse functional class and a greater number of co‐morbidities. After multivariable adjustment, the investigators found robust and statistically significant associations between increased duration of HF and heightened risk for adverse clinical outcomes . These findings were consistent across all study endpoints, including cardiovascular death, all‐cause death and hospitalization for HF.…”

“…Although Böhm et al . are to be congratulated for execution of a timely and novel analysis, limitations of this work should be highlighted . First, by virtue of the SHIFT trial selection criteria, all patients in the present analysis were required to have a diagnosis of ≥4 weeks and thus results cannot be applied to ambulatory patients with de novo or more recently diagnosed HF.…”

“…The investigators also confirmed consistent therapeutic efficacy of ivabradine across the range of HF duration included in the trial, with a near 20% relative risk reduction for the primary endpoint irrespective of HF chronicity. 6 To our knowledge, these authors present the first detailed analysis of the influence of HF duration on subsequent outcomes among ambulatory HFrEF patients.…”

The year in cardiology 2017: heart failure

“…7 Chronic kidney disease and hyperkalaemia are common in HF 8 and reasons for MRA under-use appear to be perceived risk of or actual hyperkalaemia and worsening renal function. 9 More novel drugs such as ivabradine and sacubitril/valsartan may be deferred due to clinician inertia, even though they have demonstrated benefit regardless of HF duration 10 and very early after initiation.…”