Heart failure as a 'final-stage' condition

Among cardiovascular diseases, heart failure (HF) is often referred to as a ‘final-stage’ condition. The prognosis is poor, with a mortality rate of approximately 50% within the first 5 years following diagnosis [Liao L et al. Economic burden of heart failure in the elderly. Pharmacoeconomics. 2008;26:447–62].

Patients with advanced HF (AdHF) are a relatively small but important contingent of the wider HF population who face substantial morbidity through continued deterioration of symptoms, and frequent hospitalisation. AdHF places a considerable economic burden on hospital budgets, and therapies aimed at reducing the re-hospitalisation rate have the potential to be of great economic value.

A useful contribution on this theme appeared earlier this year in the form of an abstract presented at the 2018 World Congress on Acute Heart Failure [Eur J Heart Fail. 2018;20 (Suppl. S1):398]. Prepared by Dr Josep Comin-Colet of the Bellvitge Hospital, Barcelona, Spain and fellow LION-HEART investigators, plus Spanish experts in health economics and outcomes research, this work reported on the net cost of intermittent intravenous levosimendan, given as an outpatient treatment to patients with AdHF. 

Levosimendan therapy in the LION-HEART RCT reduced the rate of hospitalisation for HF from the 66.7% seen in the control group to 22.9%. Hospitalisations for worsening HF are expensive: averting them saves money as well as improving patients’ quality of life. In the case of the Spanish centres enrolled in LION-HEART, the per-patient saving realized by using intermittent levosimendan was €2978.16. By including costs of the medications and other costs, therefore, use of intermittent levosimendan saved over €1000 per patient, net. A probabilistic analysis suggested a 94% chance of a saving.

The lesson from this research – and it’s not the first time such a lesson has emerged from pharmaco-economic analyses of levosimendan – is that the price of the drug is only part of the cost of treatment and that interventions that avert HF-related hospitalisations can in fact be much more affordable than a narrow focus on the unit price might suggest. Such outcomes are also of significant benefit to many patients and we should never lose sight of that.


Publications (22)
  • 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.


    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.

  • Recent literature

    Explore the April 2019 blog from Professor Gerhard Pölz focuses on some of the recent literature he has read.

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