Study shows lowering heart rate reduces risk of death and hospitalization by more than one quarter - literally a paradigm "SHIFT"

TORONTO, Aug. 30 /CNW Telbec/ - The results of a major international study presented at the European Society of Cardiology Congress in Stockholm and published simultaneously in The Lancet show, for the first time, that selectively lowering heart rate with a novel medication, ivabradine, significantly reduces risk of death and hospitalization for patients with heart failure.  This also resolves a longstanding debate about whether lowering heart rate itself can actually lower the risk of heart disease progression.

The study, called SHIFT, (Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial) compared a specific heart rate lowering medication, ivabradine, to placebo in addition to standard treatment for heart failure.  The conclusions will change the way patients are managed in the future.

The results show that death from heart failure was reduced significantly - by 26% (p=0.014), and that the risk of hospitalization due to worsening heart failure was also reduced by over a quarter (26%, p<0.0001) in patients receiving ivabradine. These benefits were observed after just three months of treatment with ivabradine, and the benefits were maintained over time.

The Canadian portion of this largest ever morbidity-mortality study of treatments for chronic heart failure involving over 6,500 patients from 37 countries, was led by Dr. Peter Liu at the Peter Munk Cardiac Centre, University Health Network. The data from the many centres across Canada that participated in the SHIFT trial were coordinated by the team at the Montreal Heart Institute.

"SHIFT represents a significant milestone in how physicians will treat and manage heart failure in the future. For the first time ever, we have data that confirm that heart rate plays a key role in the progression of heart failure, and this is truly a paradigm "SHIFT" for both physicians and patients," said Dr. Peter Liu, who is also President of the International Society of Cardiomyopathy and Heart Failure of the World Heart Federation, and past Scientific Chair of the Heart Failure Society of America. "Adding a unique selective heart rate lowering drug, ivabradine, to standard therapy early, dramatically reduces the risk of death and hospitalization for heart failure.  This adds an entirely new potential approach to the treatments we have available to deal with this deadly epidemic of heart failure that is already affecting one in five Canadians."

Ivabradine is not yet approved for clinical use in Canada.

About heart failure
Heart failure is a common chronic medical condition in which the heart muscle progressively weakens, and impairs the heart's ability to pump blood adequately to meet the body's needs. With an aging population, the condition is becoming more common. In fact, one in five Canadians will eventually succumb to heart failurei.  Once diagnosed, the death rate is between 20% and 30% per year, and can be worse than many of the common cancersii.  Symptoms of heart failure include fatigue and breathlessness on exertion, and can cause excessive fluid in the lungs requiring urgent hospital admission.

It is estimated that currently 500,000 Canadians are living with heart failure, and at least 50,000 new patients are diagnosed each year.iii The direct cost to the health care system exceeds $8 billion per yeariv.

SHIFT (Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial) involved over 6,500 patients participating from 37 countries with moderate to severe heart failure and heart rate above 70 beats per minute who were followed up for an average of 23 months. The study was designed to assess whether ivabradine can improve cardiovascular outcomes and symptoms and quality of life when added to standard therapy in patients with chronic heart failure and a dilated heart. The background standard therapy included any or all of angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARB), beta-blockers and/or aldosterone antagonists.  The primary endpoint was cardiovascular death or hospitalization for worsening heart failure.

The study was funded by Servier and coordinated by the SHIFT executive committee, an international group of heart failure experts.

Peter Munk Cardiac Centre 
The Peter Munk Cardiac Centre is the premier cardiac centre in Canada. Since it opened in 1997, the Centre has saved and improved the lives of cardiac patients from around the world. Each year, approximately 17,000 patients receive the innovative and compassionate care from the Peter Munk Cardiac Centre multidisciplinary heart team. In addition, the Peter Munk Cardiac Centre trains more cardiologists and cardiovascular surgeons than any hospital in Canada. The Centre is based at Toronto General Hospital - a member of University Health Network, which also includes Toronto Western Hospital and Princess Margaret Hospital. All three are research hospitals affiliated with the University of Toronto.

i Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D'Agostino RB, Kannel WB, Murabito JM, Vasan RS, Benjamin EJ, Levy D. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068-72.
ii Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV. Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation. 2003; 108:184-91.
iii Heart and Stroke Foundation. Statistics. Available at:
Accessed on August 23, 2010.
iv Arnold JM, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, Heckman GA, Howlett JG, Ignaszewski A, Johnstone DE, Jong P, McKelvie RS, Moe GW, Parker JD, Rao V, Ross HJ, Sequeira EJ, Svendsen AM, Teo K, Tsuyuki RT, White M. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol. 2006; 22:23-45.


For further information: For further information:

For media interviews, please contact:
Nicole Bodnar
Public Affairs & Communications                             
Peter Munk Cardiac Centre
416-340-4800 ext. 3417
Anita Tang
Hill and Knowlton
416-413-1218 ext. 4575

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