Ivabradine: The Start of a SHIFT in Heart Failure Treatment

Martin R Cowie


Interv Cardiol. 2013;5(1):415-426. 

In This Article

Abstract and Introduction


Epidemiological studies and clinical trials clearly demonstrate a strong association between heart rate and risk in patients with a wide spectrum of cardiac diseases. The beneficial effects of β-blockers in heart failure and in acute myocardial infarction have long been thought to be related, at least in part, to heart rate lowering. Ivabradine is a selective inhibitor of the If ion channel found in cardiac pacemaker cells of the sinoatrial node. The drug reduces heart rate at rest and during exercise in patients in sinus rhythm while maintaining myocardial contractility and atrioventricular conduction. The development of this drug has helped to tease out the effect of heart rate lowering per se. The SHIFT study reported a 10 beats per minute reduction in heart rate on top of optimal therapy, associated with an 18% relative risk reduction for cardiovascular death and hospital admission for worsening heart failure (p < 0.0001), in patients with systolic heart failure, sinus rhythm and a heart rate of 70 beats per minute or above. Measuring and recording heart rate is essential in monitoring heart failure: it conveys important prognostic information. Further studies and analyses may identify a specific 'target' resting heart rate for such patients, and establish the effect of heart rate lowering in other groups of patients, including heart failure with normal ejection fraction, acute heart failure, and those with coronary disease, but normal left ventricular function.