Intermittent levosimendan infusions reduced hospital admissions from 1.36 to 0.53 and improved NYHA class from 99% to 22% in class III at 6 months in adHF patients.
Does intermittent intravenous levosimendan reduce hospital admissions and improve functional status in patients with advanced heart failure?
Intermittent levosimendan infusions in advanced heart failure significantly reduced hospital admissions and improved functional status and estimated survival at 6 months.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Levosimendan, a calcium sensitizer with inotropic and vasodilatory effects, is utilized in advanced heart failure (adHF) for palliation or as a bridge to advanced therapies. With increasing real-world experience, evidence supporting its impact on adHF outcomes is growing. Objectives To evaluate changes in functional status, hospital admissions, and survival estimates in patients receiving intermittent intravenous (IV) levosimendan infusions in a dedicated heart failure (HF) unit. Methods We conducted a single center study of consecutive adHF patients with reduced ejection fraction, integrated in the ambulatory intermittent levosimendan infusion program of our Institution. Patients were included if: 1) they were in New York HF Association (NYHA) class III-IV; 2) they had recurrent hospital admissions; 3) intolerant to up-titration of guideline medical therapy. Exclusion criteria were acute infections, systolic arterial pressure less than 80 mmHg, severe hepatic or kidney dysfunction. They received levosimendan by continuous infusion (0,05-0,1 mcg/Kg/min) for 24 hours once a month or fortnightly, with no bolus dose. Vital signs, hemogram and biochemistry, and transthoracic echocardiogram (TTE) were evaluated before and up to 2 hours after the end of infusion. Results From January 2021 to august 2024 a total of 44 patients with 330 administrations were included. The median age was 67 (IQR 56-75) years, 84% were males (n=34). Ischemic HF was present in 64% (n=28) of patients, median ejection fraction was 23% (IQR 19-30) and 95% (n=42) were in NYHA class III. Six months after levosimendan infusion it was observed a significant reduction in hospital admissions (mean of 1.36 vs 0.53 before and after levosimendan, respectively; p0.001), a reduction in functional NYHA class (99% vs 22% of NYHA III, p0.001). There was a trend towards lower NTproBNP after each cycle, although it was not significant (mean difference -2223, p=0.141). SEATTLE-HF model was higher after 6 months of levosimendan treatment, possibly reflecting increased survival - SEATTLE-HF at 5 years 46% vs 57% before and after levosimendan treatment, respectively; p=0.01 and SEATTLE-HF at 1 year 84% vs 88%; p=0.043. Conclusion Intermittent levosimendan infusions are associated with improved functional status, reduced hospital admissions, and enhanced survival estimates in patients with adHF. A favorable trend in NT-proBNP reduction could further support its role in stabilizing disease progression.
Gerardo et al. (Sat,) reported a other. Intermittent levosimendan infusions reduced hospital admissions from 1.36 to 0.53 and improved NYHA class from 99% to 22% in class III at 6 months in adHF patients.