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.
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European Society of Cardiology 2018
Professor Gerhard Pölzl discusses the 2018 European Society of Cardiology annual meeting, which included the outcome of the VERDICT trial.
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Acute and Advanced Heart Failure: new data, new studies, new opinions, new trends
Professor Gerhard Pölzl discusses the Heart Failure Association of the European Society of Cardiology annual meeting, where several sessions were held on the use of levosimendan in heart failure.
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Acute heart failure and renal function: an organ interplay not to be underestimated
Professor Gerhard Pölzl discusses the interplay between the acutely compromised heart and the kidneys and how the optimal treatment for individual cases is complex.
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Another Uptick for Levosimendan in Advanced Heart Failure
The HFA-ESC has issued a fresh position paper [Crespo-Leiro MG et al. Eur J Heart Fail. 2018 May 27. doi: 10.1002/ejhf.1236]. Here’s our first take on some highlights.
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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.
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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.
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Heart failure and rehospitalisation
Professor Gerhard Pölzl discusses heart failure as the leading cause of adult hospitalisation in the industrialised world and what can be done to reduce this burden.
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Hospitalisation for the management of acute decompensation
Professor Gerhard Pölzl highlights Hospitalisation for the management of acute decompensation being a critical moment in the trajectory of heart failure (HF) and one that has gloomy prognostic implications for many patients.
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Inotropes for the management of acute and advanced heart failure: practical considerations, tips and tricks, future directions
Thoughts from the expert meeting organised by the Heart Failure Clinic, Attikon University Hospital, 2018.
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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.
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Levosimendan ends 2018 on a high note
At ESC-HF 2018 experts discussed how to use levosimendan safely and effectively in acute and advanced heart failure, including in the context of renal dysfunction.
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Levosimendan in Cardiac Surgery: The Evidence Adds Up
If we had a way to reduce the risk of life-threatening complications after cardiac surgery would we use it? Of course we would. It is for reason that this blog post highlights the recent work of Dr. Qiang and colleagues. See the details here.
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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.
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LION-Heart and LAICA clinical trials: differences and similarities
Professor Gerhard Pölzl highlights the LION-Heart and LAICA clinical trials.
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What could be worse than heart failure?
Professor Gerhard Pölzl highlights advanced heart failure and treatment options available for those patients that are critically vulnerable.
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Expert perspectives on acute and advanced heart failure
Professor Pölzl highlights a Supplement added at the end of 2018 to the European Heart Journal.
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Heart failure as a 'final-stage' condition
Discussion on levosimendan therapy in the LION-HEART RCT and heart failure as a 'final-stage' condition.
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LeoDOR study - progress update
See as Professor Pölzl gives an update on the progress of the LeoDOR study which is the first major trial of intermittent levosimendan.
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Levosimendan: 30 years of data and developments
Professor Pölzl discusses levosimendan and the REFALS 3 trial, which will evaluate the impact of levosimendan on respiratory function in patients with acute lateral sclerosis (ALS).
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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.