Ivabradine can be used in severe heart failure, and may improve clinical outcomes, independently of heart failure severity.1

Patients with heart rate ≥ 70 bpm
  Hazard Ratio P for interaction
Primary composite endpoint
Less severe heart failure (NYHA II or III and LVEF>20%) 0.82 0.854
Severe heart failure (NYHA IV and/or LVEF≤20%) 0.84
Cardiovascular death
Less severe heart failure 0.94 0.264
Severe heart failure 0.78
Hospitalization for worsening heart failure
Less severe heart failure 0.73 0.419
Severe heart failure 0.83


1. Borer JS, et al. Am J Cardiol. 2014;113(3):497-503.

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on the analysis of SHIFT SEVERITY

Ivabradine improves clinical outcomes independently of heart failure severity.

A recent analysis from SHIFT explored the efficacy and safety of ivabradine in 712 patients with severe heart failure (left ventricular ejection fraction ≤20% and/or NYHA class IV) and 5973 with less severe heart failure (NYHA classes II/III and left ventricular ejection fraction >20%). Treatment with ivabradine in severe heart failure was associated with relative risk reductions indistinguishable from those of less severe disease for the primary end point (16% reduction), all-cause death (22%), cardiovascular death (22%), heart failure death (37%), and heart failure hospitalization (17%) (all P for interaction nonsignificant). Moreover, in the 272 patients with severe heart failure and baseline heart rate ≥75 bpm (the indication approved by the EMA), ivabradine reduced the primary end point by 25% (P=0.045), heart failure hospitalization by 30% (P=0.042), and cardiovascular death by 32% (P=0.034). Ivabradine’s safety profile in severe heart failure was indistinguishable from that in less severe heart failure. Ivabradine can be safely used in severe heart failure and improves clinical outcomes, independently of heart failure severity.1