AIMS: To test the effect of ivabradine on the outcomes in a broad population 
with left-ventricular (LV) systolic dysfunction with coronary artery disease 
(CAD) and/or heart failure (HF).
METHODS AND RESULTS: Individual trial data from BEAUTIFUL and SHIFT were pooled 
to evaluate the effect of ivabradine on the outcomes in patients with LV 
dysfunction and heart rate ≥ 70 b.p.m. The pooled population (n = 11 897; 
baseline age 62.3 ± 10.4 years, heart rate 79.6 ± 9.2 b.p.m., and LV ejection 
fraction 30.3 ± 5.6%) was well treated according to current recommendations (87% 
beta-blockers, 90% renin-angiotensin system inhibitors). Median follow-up was 21 
months. Treatment with ivabradine was associated with a 13% relative risk 
reduction for the composite of cardiovascular mortality or HF hospitalization (P 
< 0.001 vs. placebo); this was driven by HF hospitalizations (19%, P < 0.001). 
There were also significant relative risk reductions for the composite of 
cardiovascular mortality, HF hospitalizations, or myocardial infarction (MI) 
hospitalization (15%, P < 0.001); cardiovascular mortality and non-fatal MI 
(10%, P = 0.023); and MI hospitalization (23%, P = 0.009). Similar results were 
found in patients with differing clinical profiles. Ivabradine was well 
tolerated.
CONCLUSION: Ivabradine may be important for the improvement of clinical outcomes 
in patients with LV systolic dysfunction and heart rate ≥ 70 b.p.m., whatever 
the primary clinical presentation (CAD or HF) or clinical status (NYHA class).