Inotropes for the management of acute and advanced heart failure: practical considerations, tips and tricks, future directions
An expert meeting organised by the Heart Failure Clinic, Attikon University Hospital, was held in Athens on 27-28 Sept on the theme “Inotropes for the management of acute and advanced heart failure: practical considerations, tips and tricks, future directions”. Thirty-five experts from 21 European countries ranging geographically from Finland and Russia via Turkey and Israel to Cyprus and Spain grappled with the live issues of the field, including the definitions of acute and advanced heart failure, the need for haemodynamic, neurohormonal and symptom stabilisation, the ambition for (and sometimes tension between) quality and quantity of life, the uses of inotropes and their effects on the heart, lungs, kidney, and other organs in those settings. A consensus publication on the practical use of inotropes in those settings is planned for Q1 2019, with special focus on levosimendan.
This meeting represents the continuation of an initiative developed during the past decade and intended to promote clinical awareness of levosimendan while ensuring that the science and clinical experience underpinning the drug’s status in the cardiology repertoire is subject to regular updates and rigorous scrutiny through consensus development and peer review [1-7]. Having participated in several of these meetings I can attest to the calibre of the faculties involved, the depth and breadth of the discussions and the even-handed way that data is analysed and conclusions are reached. These meetings are not just a chance to catch up with colleagues in an agreeable location: there is a commitment to reaching and publishing serious reflections on best practice. Here are some examples from previous meetings held under the same auspices, all of which reward the effort of reading.
Nieminen MS et al. The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion. Int J Cardiol. 2016;218:150-157.
Nieminen MS et al. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol. 2015;191:256-64.
Nieminen MS et al. Repetitive use of levosimendan for treatment of chronic advanced heart failure: clinical evidence, practical considerations, and perspectives: an expert panel consensus. Int J Cardiol. 2014;174(2):360-7.
Yilmaz MB et al. Renal effects of levosimendan: a consensus report. Cardiovasc Drugs Ther. 2013;27(6):581-90.
Pölzl G 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. 2012;159:82-7.
Farmakis D et al. Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper. Int J Cardiol. 2016;222:303-312.
Altenberger J et al. Levosimendan in Acute and Advanced Heart Failure: An Appraisal of the Clinical Database and Evaluation of Its Therapeutic Applications. J Cardiovasc Pharmacol. 2018;71(3):129-136.
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.
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.
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.
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.
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.