Influence of cardiovascular and noncardiovascular co-morbidities on outcomes and treatment effect of heart rate reduction With Ivabradine in stable heart failure (from the SHIFT Trial)

Böhm, M., Robertson, M., Ford, I. , Borer, J. S., Komajda, M., Kindermann, I., Maack, C., Lainscak, M., Swedberg, K. and Tavazzi, L. (2015) Influence of cardiovascular and noncardiovascular co-morbidities on outcomes and treatment effect of heart rate reduction With Ivabradine in stable heart failure (from the SHIFT Trial). American Journal of Cardiology, 116(12), pp. 1890-1897. (doi: 10.1016/j.amjcard.2015.09.029) (PMID:26508709)

Abstract

Incidence of chronic heart failure (HF) increases with age and cardiovascular (CV) morbidity. Co-morbidities increase hospitalization and mortality in HF, and non-CV co-morbidities may lead to preventable hospitalizations. We studied the impact of co-morbidities on mortality and morbidity in Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial, and investigated whether the impact of ivabradine was affected by co-morbidities. We analyzed the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trialpopulation, with moderate-to-severe HF and left ventricular dysfunction (in sinus rhythm with heart rate at rest ≥70 beats/min), according to co-morbidity: chronic obstructive pulmonary disease, diabetes mellitus, anemia, stroke, impaired renal function, myocardial infarction, hypertension, and peripheral artery disease. Co-morbidity load was classed as 0, 1, 2, 3, 4+ or 1 to 2 co-morbidities, or 3+ co-morbidities. Co-morbidities were evenly distributed between the placebo and ivabradine groups. Patients with more co-morbidities were likely to be older, women, had more advanced HF, were less likely to be on β blockers, with an even distribution on ivabradine 2.5, 5, or 7.5 mg bid and placebo at all co-morbidity loads. Number of co-morbidities was related to outcomes. Cardiovascular death or HF hospitalization events significantly increased (p >0.0001) with co-morbidity load, with the most events in patients with >3 co-morbidities for both, ivabradine and placebo. There was no interaction between co-morbidity load and the treatment effects of ivabradine. Hospitalization rate was lower at all co-morbidity loads for ivabradine. In conclusion, cardiac and noncardiac co-morbidities significantly affect CV outcomes, particularly if there are >3 co-morbidities. The effect of heart rate reduction with ivabradine is maintained at all co-morbidity loads.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Robertson, Mrs Michele and Ford, Professor Ian
• Authors: Böhm, M., Robertson, M., Ford, I., Borer, J. S., Komajda, M., Kindermann, I., Maack, C., Lainscak, M., Swedberg, K., and Tavazzi, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: American Journal of Cardiology
• Publisher: Elsevier
• ISSN: 0002-9149
• ISSN (Online): 1879-1913
• Published Online: 09 October 2015