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Influence of background treatment with mineralocorticoid receptor antagonists on ivabradine's effects in patients with chronic heart failure.
MedLine Citation:
PMID:  22892123     Owner:  NLM     Status:  Publisher    
AIMS: A post-hoc analysis of the SHIFT trial was performed to explore whether ivabradine is beneficial in patients with systolic heart failure, in sinus rhythm, with resting heart rate ≥70 b.p.m., and whose guideline-recommended background therapy includes a mineralocorticoid receptor antagonist (MRA). METHODS AND RESULTS: The effect of ivabradine on the primary composite endpoint of cardiovascular death or hospitalization for worsening heart failure, and its components, was explored in 3922 SHIFT patients with MRAs at baseline vs. 2583 patients without. Patients with MRAs were younger and were more likely to have severe heart failure and less coronary artery disease or hypertension than those without these drugs. Event rates in the placebo group were higher in patients with MRAs (33%) than in those without (23%) for the primary composite endpoint, with a 40% increase in relative risk (hazard ratio 1.40, 95% confidence interval 1.22-1.61). This was also true for secondary endpoints related to mortality or hospitalization. The effect of ivabradine on reducing the primary endpoint was similar in patients with and without MRAs (P = 0.916 for interaction, adjusted for prognostic factors at baseline), as were its effects on cardiovascular death (P = 0.279), hospitalizations for heart failure (P = 0.304), and death from heart failure and from all causes (P = 0.723 and 0.366, respectively). There was no difference in the safety of ivabradine in the two subpopulations. CONCLUSION: Ivabradine improves outcomes in heart failure patients with heart rate ≥70 b.p.m. receiving multiple neurohormonal modulation treatments (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and MRA). The addition of ivabradine to multiple neurohormonal modulation should therefore be considered when the heart rate is ≥70 b.p.m.
Michel Komajda; Michael Böhm; Jeffrey Borer; Ian Ford; Henry Krum; Adrian Tase; Luigi Tavazzi; Karl Swedberg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  European journal of heart failure     Volume:  -     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiology, Université Pierre et Marie Curie Paris VI, La Pitié-Salpétrière Hospital, 75013 Paris, France.
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