Heart failure and rehospitalisation

Heart failure is the leading cause of adult hospitalisation in the industrialised world and imposes a substantial burden on public health. The later stages of heart failure are characterised by a steady decline in quality of life and frequent re-hospitalisation for recurrent acute symptoms.1 Most of the re-hospitalisations take place relatively soon after discharge from the index hospitalisation. About one quarter of patients are re-hospitalised within one month, and more than 60% of these are seen within 15 days after initial discharge.2

Several clinical studies have been performed on the repetitive use of intravenous levosimendan in advanced heart failure.3 Their results suggest that repeated infusions of levosimendan bring advantages to patients with advanced chronic heart failure, both as it regards mortality4 and re-hospitalisation.However, few of these studies were properly powered. Therefore, a larger study is needed to verify the results.

In the newly commenced LEODOR trial the efficacy and safety of intermittent levosimendan therapy, beginning during the vulnerable phase after a recent hospitalisation for heart failure, is tested. The hypothesis is that, compared with placebo, repetitive administration of levosimendan in the post-acute heart failure syndrome discharge period will be associated with greater clinical stability through 14 weeks, as assessed by a composite clinical endpoint consisting of mortality, acute heart failure episodes and change in natriuretic peptide levels.

References

  1. Fruhwald S, Pollesello P, Fruhwald F. Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations. Expert Rev Cardiovasc Ther. 2016;14:1335-47.
  2. Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, et al. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ. 2013;347:f6571.
  3. Pölzl G, Altenberger J, Baholli L, Beltrán P, Borbély A, Comin-Colet J, et al. Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy. Int J Cardiol 2017;pii:S0167-5273(17)31017-3.
  4. Silvetti S & Nieminen MS. Repeated or intermittent levosimendan treatment in advanced heart failure: An updated meta-analysis. Int J Cardiol. 2016;202:138-43.
  5. Silvetti S, Belletti A, Fontana A, Pollesello P. Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials. ESC Heart Fail 2017. doi: 10.1002/ehf2.12177.

 

Publications (13)
  • ESC 2017 in Barcelona

    Professor Gerhard Pölzl discusses the European Society of Cardiology annual meeting 2017, where several sessions were held on the use of levosimendan in heart failure.

  • FIGHT, PERSIST and LEVOREP

    Professor Gerhard Pölzl highlights the significance of the FIGHT, PERSIST and LEVOREP trials which investigate levosimendan as a treatment for heart failure.

  • LEODOR trial - recent advances

    There have been some recent achievements in the LEODOR trial including a new website to facilitate administration and communication and submission of a formal study protocol synopsis to the European Journal of Heart Failure.

  • Levosimendan roars ahead as LION-HEART results published

    Professor Gerhard Pölzl reports primary results from the LION-HEART study in the management of advanced heart failure where among secondary endpoints, patients treated with levosimendan experienced a reduction in the rate of HF-related hospitalisation compared with placebo.

  • What does the Advanced Heart Failure patient want?

    Professor Cynthia M Dougherty and colleagues outline an array of options for the treatment of advanced heart failure (HF) that create – quite reasonably – the impression that we are in a golden age of therapeutic possibilities for this difficult condition.

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