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
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
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.
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.
and Stroke Foundation. Statistics. Available at: http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm
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;
SOURCE PETER MUNK CARDIAC CENTRE
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