Adding ivabradine to standard treatment significantly reduced hospitalisation and deaths from heart failure, in a randomised, placebo-controlled trial. Ivabradine is a new rate-limiting drug which acts as a selective inhibitor of a sodium-potassium channel highly expressed in the sinoatrial node. A total of 6,558 patients with NYHA class ll-lV heart failure, an LVEF ≤ 35%, a resting heart rate ≥ 70 bpm, and a hospital admission for heart failure within the previous year were enrolled in the SHIFT study. 'Critics of the trial have cited an atypical patient population and suboptimal beta-blocker dosing (only 56% of patients were on ≥ 50% of beta-blocker target dosage and only 26% were on the target dosage). However, I think the study population represents a fairly typical real-world situation and would take the result of this trial as encouraging.'