How Many Heart Failure Patients Might We SHIFT to a Lower Heart Rate?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
See Article by Das et al
For fast acting relief, try slowing down.
For years, β-blockers were strongly contraindicated in patients with heart failure. The pendulum has swung far from that position, and for patients with heart failure with reduced ejection fraction, β-blockers are now standard of care. It has been argued that persistent tachycardia may pose ongoing risk, and additional efforts to slow heart rate may further relieve a failing heart. Ivabradine presents an alternative option for reducing heart rate through If channel current inhibition. SHIFT (Systolic Heart Failure Treatment With the IF Inhibitor Ivabradine Trial) studied its use in patients with New York Heart Association functional class II-IV heart failure with ejection fraction ≤35% and heart rate >70 beats per minute, despite background medical therapy, and found a reduction in the end point of cardiovascular death or heart failure hospitalization.1 This finding was driven mostly by reduction in hospitalization, and 2 important outstanding questions were highlighted in the accompanying editorial: concern over generalizability/applicability and whether the findings may have been an association with and not a consequence of treatment.2 Despite these limitations, SHIFT was a landmark heart failure trial of a novel agent, and ivabradine has earned a IIa recommendation (level of evidence: B-R) in the recently published American College of Cardiology/American Heart Association/Heart Failure Society of America HF Guideline Focused Update.3 Ongoing awareness of the importance of adequate background β-blocker therapy was highlighted in the commentary, “Given the well-proven mortality benefits of β-blocker therapy, it is important to initiate and uptitrate these agents to target doses, as tolerated, before assessing the resting …