Journal Article

Safety Profile and Efficacy of Ivabradine in Heart Failure Due to Chagas Heart Disease: A Post Hoc Analysis of the SHIFT Trial

Guimarães, Guilherme Veiga, Bocchi, Edimar Alcides, Rassi, Salvador

2018

Overview

Abstract Aims The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. Methods and results SHIFT was a randomized, double-blind, placebo-controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta-blocker. ChD HF presented a poor prognosis (all-cause mortality at 2 years was ~60%). The mean twice-daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all-cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. Conclusions ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit–risk profile in ChD HF patients.

• Publisher: Oxford University Press
• Subject: Argentina - epidemiology / Blood pressure / Brazil - epidemiology / Cardiovascular Agents - administration & dosage / Chagas disease / Chagas Disease - complications / Chagas Disease - diagnosis / Chagas Disease - physiopathology / Chagasic cardiomyopathy / Chronic obstructive pulmonary disease / Diabetes / Dose-Response Relationship, Drug / Double-Blind Method / Drug Administration Schedule / Family medical history / Female / Follow-Up Studies / Heart failure / Heart Failure, Systolic - drug therapy / Heart Failure, Systolic - etiology / Heart Failure, Systolic - physiopathology / Heart rate / Heart Rate - drug effects / Humans / Hypertension / Ivabradine / Ivabradine - administration & dosage / Male / Medical prognosis / Middle Aged / Mortality / SHIFT trial / Statistical analysis / Stroke Volume - drug effects / Survival Rate - trends / Treatment Outcome / Ventricular Function, Left