Elevated heart rate is a risk factor in chronic heart failure. Heart rate reduction by means of Β-blocker therapy is associated with improved outcomes. However, in real life conditions, many heart failure patients remain with increased heart rate due to suboptimal dosing of Βblockers because of poor tolerability and/or physician reluctance to use these agents. SHIFT (Systolic Heart failure treatment with If inhibitor ivabradine Trial) has shown that addition of the If current inhibitor ivabradine, a selective heart rate–reducing agent devoid of any other significant pharmacological properties, on top of the best possible recommended therapy including
Βblockers at the maximum tolerated dosage, improved outcomes in heart failure patients with low ejection fraction and heart rate ≥70 bpm. (...)