Effect of visit-to-visit variation of heart rate and systolic blood pressure on outcomes in chronic systolic heart failure: Results from the systolic heart failure treatment with the if inhibitor ivabradine trial (shift) trial

Background-elevated resting heart rate (hr) and low systolic blood pressure (sbp) are related to poor outcomes in heart failure (hf). the association between visit-to-visit variation in sbp and hr and risk in hf is unknown. methods and results-in systolic heart failure treatment with the if inhibitor ivabradine trial (shift) patients,we evaluated relationships between mean hr,mean sbp,and visit-to-visit variations (coefficient of variation [cv]=sd/mean9100%) in sbp and hr (sbp-cv and hr-cv,respectively) and primary composite endpoint (cardiovascular mortality or hf hospitalization),its components,all-cause mortality,and all-cause hospitalization. high hr and low sbp were closely associated with risk for primary endpoint,all-cause mortality,and hf hospitalization. the highest number of primary endpoint events occurred in the highest hr tertile (38.8% vs 16.4% lowest tertile,p<0.001). for hr-cv,patients at highest risk were those in the lowest tertile. patients in the lowest thirds of mean sbp and sbp-cv had the highest risk. the combination of high hr and low hr-cv had an additive deleterious effect on risk,as did that of low sbp and low sbp-cv. ivabradine reduced mean hr and increased hr-cv,and increased sbp and sbp-cv slightly. conclusions-beyond high hr and low sbp,low hr-cv and low sbp-cv are predictors of cardiovascular outcomes with additive effects on risk in hf,but with an unknown effect size. beyond hr reduction,ivabradine increases hr-cv. low visit-to-visit variation of hr and sbp might signal risk of cardiovascular outcomes in systolic hf. clinical trial registration-url: http://www.isrctn.com/. unique identifier: isrctn70429960. © 2016 the authors.