A 60-year-old man with ischemic cardiomyopathy and LVEF 28% is on sacubitril/valsartan, carvedilol, spironolactone, and dapagliflozin. His resting heart rate is 74 bpm in sinus rhythm despite maximally tolerated beta-blocker. NT-proBNP remains elevated. Which drug has proven benefit in this specific scenario based on the SHIFT trial?
- A Digoxin
- B Ivabradine ✓
- C Vericiguat
- D Hydralazine-nitrate combination
Correct answer: B. Ivabradine
Explanation
The SHIFT trial demonstrated that ivabradine (a selective If channel inhibitor in the sinoatrial node) reduces the composite of cardiovascular death and heart failure hospitalization in patients with LVEF ≤35%, sinus rhythm, resting HR ≥70 bpm on maximally tolerated beta-blocker (or beta-blocker contraindicated), and NYHA class II-IV. The patient meets all these criteria. Vericiguat (VICTORIA trial) is for recent worsening heart failure, not stable chronic HFrEF with elevated resting HR.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.