s ystolic h eart failure treatment with the i f inhibitor ivabradine t rial
DESCRIPTION
S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial. Efficacy and safety of ivabradine in patients with chronic systolic heart failure according to blood pressure level in SHIFT. www.shift-study.com. Komajda M et al. Eur J Heart Fail. 2014;16(7):810-816. - PowerPoint PPT PresentationTRANSCRIPT
Systolic Heart failure treatment with
the If inhibitor ivabradine Trial
Efficacy and safety of ivabradine in patients
with chronic systolic heart failure according
to blood pressure level in SHIFT
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
<115 115 to <130 >=1300
10
20
30
40
50
<74 bpm
74 to <81 bpm
≥81 bpm
<115 mm Hg 115 to <130 mm Hg ≥130 mm Hg
Rate of primary end point (cardiovascular mortality or hospitalization for worsening heart failure), %
Systolic blood pressure at baseline
Heart rate at baseline
P=0.0058 for
difference between the groups
Outcomes in placebo patients grouped according to tertiles of systolic blood
pressure and resting heart rate
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
0
10
20
30
40
50
0 1 2 3Time (years)
<115 mm Hg 1069 907 759 592 288 117 6
115 to <130 mm Hg 991 873 760 646 350 141 4
≥130 mm Hg 1204 1088 970 823 451 181 7
Numbers at risk
P=0.0003 for difference between the groups
<115 mm Hg
115 to <130 mm Hg
≥130 mm Hg
Outcomes in placebo patients according to tertiles of baseline systolic blood pressure
Rate of primary end point (cardiovascular mortality or hospitalization for worsening heart failure), %
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
0
10
20
30
40
50
0 1 2 3
Baseline systolic blood pressure <115 mm Hg
Placebo 1069 907 759 592 288 117 6
Ivabradine 1041 911 784 624 287 115 3
Numbers at risk
Inci
den
ce o
f p
rim
ary
end
po
int
(%) Placebo
Ivabradine
HR 0.84 (95% CI, 0.72 to 0.98), P=0.022
Time (years)
Effect of ivabradine on primary outcomes (CV death or HF hospitalization) according
to systolic blood pressure level
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
0
10
20
30
40
50
0 1 2 3
Placebo 991 873 760 646 350 141 4
Ivabradine 977 874 782 664 381 131 4
Numbers at risk
Inci
den
ce o
f p
rim
ary
end
po
int
(%)
HR 0.86 (95% CI, 0.72 to 1.03), P=0.099
Time (years)
Baseline systolic blood pressure 115 to <130 mm Hg
Effect of ivabradine on primary outcomes (CV death or HF hospitalization) according
to systolic blood pressure level
Placebo
Ivabradine
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
0
10
20
30
40
50
0 1 2 3
Placebo 1204 1088 970 823 451 181 7
Ivabradine 1223 1143 1034 885 523 201 9
Numbers at riskTime (years)
Inci
den
ce o
f p
rim
ary
end
po
int
(%) HR 0.77 (95% CI, 0.66 to 0.92), P=0.003
Baseline systolic blood pressure ≥130 mm Hg
Effect of ivabradine on primary outcomes (CV death or HF hospitalization) according
to systolic blood pressure level
Placebo
Ivabradine
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
0
10
20
30
40
50
0 1 2 3
Baseline SBP <115 mm Hg
HR 0.84 (95% CI, 0.72 to 0.98),
P=0.022
Time (years)
0
10
20
30
40
50
0 1 2 3
HR 0.86 (95% CI, 0.72 to 1.03),
P=0.099
Time (years)
Baseline SBP 115 to <130 mm Hg
0
10
20
30
40
50
0 1 2 3Time (years)
HR 0.77 (95% CI, 0.66 to 0.92),
P=0.003
Baseline SBP≥130 mm Hg
Effect of ivabradine on primary outcomes (CV death or HF hospitalization) according
to systolic blood pressure level
Rate of primary end point (cardiovascular mortality or hospitalization for worsening heart failure), %
Placebo
Ivabradine
Placebo
Ivabradine
Placebo
Ivabradine
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
P for interaction =0.68
Adjusted hazard ratioP-value P-value for
interaction
Cardiovascular mortality <115 mm Hg 0.89 0.24 0.91115 to <130 mm Hg 0.96 0.723 ≥130 mm Hg 0.91 0.42 Hospitalization for worsening heart failure<115 mm Hg 0.78 0.007 0.79115 to <130 mm Hg 0.74 0.005 ≥130 mm Hg 0.71 0.001 Heart failure mortality <115 mm Hg 0.71 0.046 0.18115 to <130 mm Hg 0.58 0.033 ≥130 mm Hg 1.16 0.59 All-cause mortality <115 mm Hg 0.92 0.36 0.90115 to <130 mm Hg 0.94 0.57 ≥130 mm Hg 0.87 0.23
Effect of ivabradine on other outcomes according to baseline systolic blood pressure
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.
SBP, mm Hg <115 115 to <130 ≥130
IVA, % PL, % P IVA, % PL, % P IVA, % PL, % P
Symptomatic
bradycardia
0.3 0.1 0.37 0.9 0.1 0.011 0.7 0.2 0.14
Asymptomatic
bradycardia
0.9 0.2 0.031 1 0.2 0.007 0.6 0.1 0.070
Atrial
fibrillation
4 4.2 0.43 4 3 0.25 5 3 0.030
Phosphenes 0.5 0 0.029 0 0 0.2 0.2 0.69
Hypotension 0.1 0.2 1.00 0.1 0 0.50 0 0
Adverse event leading to withdrawal according to systolic blood pressure level
www.shift-study.comKomajda M et al. Eur J Heart Fail. 2014;16(7):810-816.