Tavazzi, L., Swedberg, K., Komajda, M., Bohm, M., Borer, J.S., Lainscak, M. and Ford, I. (2013) Efficacy and safety of ivabradine in chronic heart failure across the age spectrum: insights from the SHIFT study. European Journal of Heart Failure, 15(11), pp. 1296-1303. (doi: 10.1093/eurjhf/hft102)
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Abstract
Aims: To test whether the efficacy and safety of the selective heart rate-reducing agent ivabradine changes according to age in chronic heart failure (HF) patients.<p></p> Methods and results: The ivabradine and placebo arms of SHIFT, which enrolled 6505 chronic HF patients, were combined and age distribution was divided by quartiles to give four groups (<53 years, n = 1522; 53 to <60 years, n = 1521; 60 to <69 years, n = 1750; and ≥69 years, n = 1712). The effects of ivabradine on cardiovascular outcomes, changes in heart rate, and adverse events, particularly bradycardia, were evaluated according to age group. A subgroup (602 patients) underwent 24 h ambulatory ECG Holter monitoring. The relative risk of the primary endpoint (cardiovascular death or hospitalization for worsening HF) was reduced by ivabradine in all age groups, ranging from 38% [hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.50–0.78, P < 0.001] in the youngest patients <53 years to 16% (HR 0.84, 95% CI 0.71–0.99, P = 0.035) in the oldest patients ≥69 years. Ivabradine up-titration reduced heart rate similarly in all age groups, by 11 b.p.m. As anticipated, bradycardia and phosphenes occurred more frequently with ivabradine, at a similar rate whatever the age. In the Holter substudy, there were no episodes of severe bradycardia and no clinically relevant pauses with ivabradine in any age group.<p></p> Conclusions: Age does not limit the appropriate use of ivabradine in patients with chronic HF and systolic dysfunction. The safety and efficacy of ivabradine are comparable across all age groups.<p></p>
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Ford, Professor Ian |
Authors: | Tavazzi, L., Swedberg, K., Komajda, M., Bohm, M., Borer, J.S., Lainscak, M., and Ford, I. |
College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | European Journal of Heart Failure |
ISSN: | 1388-9842 |
ISSN (Online): | 1879-0844 |
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