发布日期：2010-09
英文标题：
Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial.
作者：
Böhm M, Swedberg K, Komajda M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L; SHIFT Investigators.
出处：
Lancet. 2010 Sep 11;376(9744):886-94.
内容介绍：SHIFT 研究是一项随机双盲安慰剂平行对照研究，入组 6558 例窦性心律 HR ≥ 70bpm，LVEF ≤ 35% 的慢性心力衰竭患者，在常规治疗基础上，随机分为安慰剂组及伊伐布雷定组，中位随访 22.9 个月，最长随访时间: 41.7 个月。该亚组分析是评价伊伐布雷定组及安慰剂组基线心率 (不同分层) 与终点事件发生率的关系，以及基线及治疗 28 天后不同心率分层人群心率降低对预后的影响。结果显示心率增快导致心衰患者远期预后不良，心率控制在 60bpm 以下时主要终点事件最低
摘要展示：
BACKGROUND: Raised resting heart rate is a marker of cardiovascular risk. We postulated that heart rate is also a risk factor for cardiovascular events in heart failure. In the SHIFT trial, patients with chronic heart failure were treated with the selective heart-rate-lowering agent ivabradine. We aimed to test our hypothesis by investigating the association between heart rate and events in this patient population.
METHODS: We analysed cardiovascular outcomes in the placebo (n = 3264) and ivabradine groups (n = 3241) of this randomised trial, divided by quintiles of baseline heart rate in the placebo group. The primary composite endpoint was cardiovascular death or hospital admission for worsening heart failure. In the ivabradine group, heart rate achieved at 28 days was also analysed in relation to subsequent outcomes. Analysis adjusted to change in heart rate was used to study heart-rate reduction as mechanism for risk reduction by ivabradine directly.
FINDINGS: In the placebo group, patients with the highest heart rates (>or = 87 beats per min [bpm], n = 682, 286 events) were at more than two-fold higher risk for the primary composite endpoint than were patients with the lowest heart rates (70 to <72 bpm, n = 461, 92 events; hazard ratio [HR] 2.34, 95% CI 1.84-2.98, p<0.0001). Risk of primary composite endpoint events increased by 3% with every beat increase from baseline heart rate and 16% for every 5-bpm increase. In the ivabradine group, there was a direct association between heart rate achieved at 28 days and subsequent cardiac outcomes. Patients with heart rates lower than 60 bpm at 28 days on treatment had fewer primary composite endpoint events during the study (n = 1192; event rate 17.4%, 95% CI 15.3-19.6) than did patients with higher heart rates. The effect of ivabradine is accounted for by heart-rate reduction, as shown by the neutralisation of the treatment effect after adjustment for change of heart rate at 28 days (HR 0.95, 0.85-1.06, p = 0.352).
INTERPRETATION: Our analysis confirms that high heart rate is a risk factor in heart failure. Selective lowering of heart rates with ivabradine improves cardiovascular outcomes. Heart rate is an important target for treatment of heart failure.
