Expert reflections from Heart Failure 2019

Our June 2019 blog post from Professor Gerhard Pölzl picks out the highlights from the recent Heart Failure congress.

Back from the Heart Failure congress in Athens with pleasant memories, new acquaintances, and a big bag of information and ideas.

The LEODOR study on ‘repetitive use of levosimendan in advanced heart failure patients’ was reviewed in the main programme (see presentation in MyESC) and an investigator meeting was held to discuss progress in the initiation of the centres and the enrollment of patients.

As regards the inodilator levosimendan, many posters were presented and a series of tutorials on i.v. vasoactive drugs in the treatment of acute and advanced heart failure was held by 12 speakers from Austria, Cyprus, Finland, Germany, Greece, Hungary, Italy, Spain, Sweden, and Switzerland. These lectures were recorded, and the videos are available on the landing page www.acutehf.com/hf for educational purposes.

The use of i.v. vasoactive drugs, diuretics, vasodilators and inotropes, for correcting haemodynamic dysfunction in patients with congestive heart failure has been described over many decades. Despite this, the speakers agreed that insufficient data has been collected on their effects on Quality of life (QoL) and long-term survival. Of particular note is that for inotropes belonging to the cardiac glycoside, catecholamine, and phosphodiesterase inhibitor families, data on the impact of these agents on QoL and survival are not positive, and in several cases indicate an increase in mortality risk.

In acute heart failure, selecting the proper agent according to a patients’ clinical profile and limiting its usage to the shortest time at the lowest effective dose are important considerations to optimise inotrope use. In these settings, levosimendan bears an additional advantage due to its beneficial renal effects. Also, levosimendan’s overall haemodynamic profile and clinical tolerability, combined with its extended duration of effect, has encouraged its intermittent use in patients with advanced heart failure to promote functional independence, quality of life and to avert the need for unplanned hospitalisations resulting from episodes of decompensation. Further clinical research is in progress to refine the drug’s use for this purpose.

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