Abstract 3815: The Intermittent Infusion of Levosimendan Reduces Mortality and Re-admisions in Patients With Advanced Heart Failure
Introduction: The prognosis of patients with advanced heart failure, who do not qualify for heart transplantation, is poor. The use of intermittent infusions(pulses)of inotropes, mainly beta-adrenergic and phosphodiesterase III inhibitors drugs has been associated with improved clinical condition in selected groups, but it has been also related to an increased mortality rate. Thus this strategy is not regarded as a first-line treatment choice, and is directly contraindicated by some guidelines. The objective of the present study was to consider the use of pulses of Levosimendan in patients with advanced heart failure assessing their mortality rate and necessity of re-hospitalization at 6 and 12 months.
Methods: Patients with advanced heart failure, who are not candidates for heart transplantation, with a recent hospitalization for heart failure requiring intravenous inotropic treatment were randomly assigned to: pulses of Levosimendan(0.1 mcg/kg/min for 24 hours) schedulled every 2 months, or placebo, in addition to optimal medical treatment.
Results:From 80 patients enrolled, 40 ones were randomized to Levosimendan, in pulses(0.1 mcg/kg/min) schedulled every 3 months, and another 40 patients represented the control group, with both receiving optimal medical treatment. The general characteristics were comparable. The Levosimendan treated patients exhibited a reduced mortality at 6 months: 4(10%) versus 13(32.5%) and 12 months: 6(15%) versus 19(47.5%). The rate of re-admision was also inferior at 6 months: 9(22.5%) versus 31(77.5%) and 12 months: 17(42.5%) versus 39(97.5%-P value<0.05 in all cases).
Conclusion: In a randomized comparison in patients with advanced heart failure which are not candidates for cardiac transplant, the intermittent infusion of Levosimendan reduced the mortality and the need of re-admision at 6 and 12 months.