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Clinical experience with ambulatory perfusion of levosimendan in an advanced heart failure unit

Session Poster Session 3

Speaker Carles Moliner

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : J Pamies-Besora (Barcelona,ES), C Moliner-Abos (Barcelona,ES), P Fluvia (Barcelona,ES), M Rivas-Lasarte (Barcelona,ES), J Alvarez-Garcia (Barcelona,ES), S Mirabet (Barcelona,ES), L Lopez (Barcelona,ES), V Brossa (Barcelona,ES), E Roig (Barcelona,ES)

Authors:
J Pamies-Besora1 , C Moliner-Abos1 , P Fluvia1 , M Rivas-Lasarte1 , J Alvarez-Garcia1 , S Mirabet1 , L Lopez1 , V Brossa1 , E Roig1 , 1Hospital de la Santa Creu i Sant Pau, Cardiology - Barcelona - Spain ,

Citation:

Introduction: ambulatory inotropic treatment in patients with advanced heart failure has been associated with clinical benefits and with a reduction in the hospitalization rate.

Purpose: To analyse the clinical benefit of ambulatory levosimendan perfusion in an advanced heart failure unit.

Methods: retrospective, unicentric study involving patients with chronic heart failure in NYHA III-IV with low cardiac output symptoms who received ambulatory levosimendan infusions between December 2015 and April 2018. We analysed baseline characteristics, the indication of inotropic treatment, the number of infusions, the number of hospitalizations 6 months before and after the infusions and mortality and transplant follow-up.

Results: During the study 149 ambulatory infusions were performed in 61 patients, aged 66±12 years old and 82% men, with LVEF of 26 ±7% and glomerular filtration rate of 52±21 ml/min. Baseline treatment is registered in Table 1 and the underlying disease in figure 1. 46% of all patients received = 2 infusions and 23% received =3.  We found a non-significant (p=0,06) decrease in hospitalisation rate (RRR 35%) and a clinical improvement.

In a follow-up over a period of 9,6±6 months 18 patients died (30%), 15 due to a cardiovascular event. Death was associated with worse renal function (p=0,02). Out of 14 patients in list for heart transplant, none died, 10 (71%) reached transplant and 1 underwent ventricular assist device (Heart-Mate III) implantation.

Conclusions: Ambulatory infusion of levosimendan was related with a clinical improvement and a non-significant decrease in hospitalisation for acute heart failure. In 23% of cases, the indication was a bridge to transplant.

Drug % treated patients

Dose

≥50%
BB 89 26
ACEI/ARB 74 21
MRA 77 53
ARNI 8 7
Ivabradine 18 17
Diuretic 95
Amiodarone 15
Digoxin 23
BB- Betablocker ACEI- Angiotensin Converter Enzime Inhibitor ARB- Angiotensin II Receptor Blocker MRA- Mineralocorticoid Receptor Antagonist ARNI- Angiotensin Receptor Neprilisine Inhibitor

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