CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
528
AFRICA
Ivabradine reduces total hospital burden in heart failure
Heart rate reduction using ivabradine in
patients with chronic heart failure who
were in sinus rhythm and with heart
rates of at least 70 beats/min resulted in
substantially reduced clinical deterioration
in total hospitalisations for worsening
heart failure and in an increase in time
to first and subsequent hospitalisations.
1
This was despite patients being treated
with guideline-based background therapy,
including maximally treated beta-
blockade.
Presenting the results of the
post-
hoc
analysis of the SHI
f
T study, which
focused on recurrent hospitalisation, Prof
Jeffrey Borer, New York, stressed that
ivabradine therapy did not unmask any
other problems that would lead to hospi-
talisation. ‘In the Total Time Analysis,
the time to occurrence of hospitalisation
for heart failure was reduced for first
events by 25%, for second events by
34%,
and for a third event by 29%. All of
these reductions were highly statistically
significant’, Prof Borer pointed out.
Another way of evaluating the
hospitalisation data focused on the
causes of hospitalisation. In this review,
hospitalisation for worsening heart failure
was reduced by 25%, hospitalisation for
any cause by 15%, and hospitalisation
for cardiovascular-related events by 16%.
Overall hospitalisations other than for
worsening heart failure were reduced
by 8%, which did not, however, reach
statistical significance.
Acknowledging some of the normal
limits of a
post-hoc
study and the fact
that the treatment effect is dependent on
previous hospitalisations (the cumulative
effect of the first, second and third event)
anddifferences inhospitalisationburden in
different countries, Prof Borer nonetheless
concluded that ivabradine reduces the total
burden on the patient and the healthcare
system. ‘The financial burden can be
expected to be substantially reduced when
ivabradine is added to guideline-based
heart-failure therapies’, he concluded.
J Aalbers
1.
Borer JS, Böhm M, Ford I, Komajda M,
et al
.
Effect of ivabradine on recurrent
hospitalization for worsening heart failure
in patients with chronic systolic heart fail-
ure: the SHIFT study
.
Eur Heart J
. 12
Sept
2012 [
Epub ahead of print]. doi:10.1093/
eurheartj/ehs259.
GARFIELD: a window on the real-life treatment of atrial fibrillation
South Africa joins the GARFIELD registry
The results of the evaluation of the
first cohort of 10 000 newly diagnosed
atrial fibrillation (AF) patients in the
GARFIELD registry, which reflects
contemporary global real-life treatment of
AF, has shown that fewer than half of the
eligible patients received anticoagulant
therapy with vitamin K antagonists. In
addition, those patients at significantly
increased risk of experiencing stroke
or systemic emboli with a CHADS
2
risk score greater than 2 were poorly
treated. Patients who were not really
at risk (those with a CHADS
2
score of
zero) and who did not generally require
anticoagulation treatment were frequently
given anticoagulant therapy in some 80%
of cases.
The GARFIELD (Global Anti-
coagulant Registry in the FIELD)
seeks better understanding of these
contradictions in an academically driven
project, led by the UK-based Thrombosis
Research Institute and funded with an
unrestricted grant from Bayer Healthcare.
Prof Barry Jacobson, haematologist,
Witwatersrand University, will lead the
South African arm of the registry which
has now begun to document and track
non-valvular AF patients with at least
one additional cardiovascular risk factor.
Patients will be recruited at both primary
and specialist-care levels in the country.
Speaking at a special symposium at
the 2012 ESC congress, Prof Lord Ajay
Kakkar, University College Hospital,
London, noted that the registry aims
to describe treatment patterns that
reflect the real world beyond so-called
centres of excellence. ‘It includes the
many diverse places where doctors are
working, including those placed in less
well-resourced settings. We need to be
sensitive to the extent of the stroke-
prevention challenges the world will face
over the next 30 years, as the number
of stroke cases are set to double in both
middle- and low-income countries. This
registry will help us to develop value-
based healthcare approaches which can
be applied in a wide variety of clinical
settings’, he concluded.
Patients in the registry will be followed
for at least two years. Importantly, the
registry includes a patient-satisfaction
questionnaire and seeks to explore the
in-practice bridging of anticoagulation
when vitamin K antagonist therapy is
interrupted.
ProfAlexTurpie,McMasterUniversity,
Canada pointed out that experience within
GARFIELD will also allow evaluation of
combination therapies in patients with AF
and other cardiovascular co-morbidities.
‘
All of the new anticoagulant agents have
been Q-tested in phase II trials in ACS
and appear to have potential. However,
rivaroxiban is the only drug to date that
has been shown in phase III trials to be
beneficial in this setting’, he pointed out.
Expert comment
Prof Barry Jacobson’s views on
the new SA-based initiative
‘
I feel that this study will help us
understand not only how patients who
have access to First-world medicine are
treated but also how indigent patients are
managed in a Third-world setting’, says
Prof Jacobson.
J Aalbers
