Voors, A. A., van Veldhuisen, D. J., Robertson, M., Ford, I. , Borer, J. S., Bohm, M., Komajda, M., Swedberg, K. and Tavazzi, L. (2014) The effect of heart rate reduction with ivabradine on renal function in patients with chronic heart failure: an analysis from SHIFT. European Journal of Heart Failure, 16(4), pp. 426-434. (doi: 10.1002/ejhf.59)
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Abstract
Aims: We studied the relationship between heart rate and renal function and the effects of heart rate reduction with ivabradine in heart failure patients with and without renal dysfunction.<p></p> Methods and results: From the 6505 patients who were randomized in SHIFT, baseline creatinine and at least one follow-up measurement were available in 6160 patients. Median follow-up was 22.9 months. Worsening renal function (WRF) was defined as a creatinine increase of ≥0.3 mg/dL and ≥25% from the baseline value. WRF developed in 1029 (17%) patients and was directly related to baseline heart rate, with an incremental risk of 5% for every 5 b.p.m. heart rate increment (P = 0.003). WRF was associated with an increased risk of the primary composite endpoint of hospitalization for worsening heart failure or cardiovascular death [hazard ratio (HR) 1.38, P < 0.001] and of all-cause mortality (HR 1.42, P< 0.001). Ivabradine use was associated with a reduction of the primary composite endpoint in patients both with (HR 0.82, P = 0.023) and without renal dysfunction (HR 0.81, P < 0.001) at baseline (P for interaction = 0.89), and tolerability of ivabradine was comparable in the two groups. No differences were found in changes in renal function over time between ivabradine- and placebo-treated patients.<p></p> Conclusion: In chronic stable systolic heart failure patients, heart rate is directly and independently associated with the risk of WRF, but reduction in heart rate by ivabradine had a neutral effect on renal function during 2 years of follow-up. The beneficial cardiovascular effects and safety of ivabradine were similar in patients with and without renal dysfunction.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Robertson, Mrs Michele and Ford, Professor Ian |
| Authors: | Voors, A. A., van Veldhuisen, D. J., Robertson, M., Ford, I., Borer, J. S., Bohm, M., Komajda, M., Swedberg, K., and Tavazzi, L. |
| Subjects: | R Medicine > R Medicine (General) |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | John Wiley & Sons Ltd. |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
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