On the 27–28 May 2018, the Heart Failure 2018 Congress of the European Society of Cardiology–Heart Failure Association convened in Vienna, Austria. As part of this lively Congress, experts from nine European countries delivered an insightful series of tutorials examining how to use levosimendan safely and effectively in acute and advanced heart failure, including in the context of renal dysfunction.
Those insights have now been distilled into print, with the European experts sharing their experience and views on the position of levosimendan in the management of acute and advanced heart failure in a review published in Cardiovascular Drugs and Therapy (Bouchez S et al. 2018). It seems fitting that we should conclude our monthly blog posts for 2018 with a brief summary of this excellent tour d’horizon from a group of notable and respected practitioners in this complex field.
A series of major points emerged from this review:
Meta-analyses of levosimendan data in various settings, including acute heart failure (AHF) and advanced heart failure (AdHF), indicated a trend towards a survival benefit that reached statistical significance in some investigations, though not all. Of note, however, none of these meta-analyses produced any indication that the use of levosimendan is associated with an increase in mortality, whereas a worsening impact on survival has been reported for other inotropes and inodilators.
In AdHF, a meta-analysis indicated a clear and consistent effect of levosimendan on reducing re-hospitalisations. Given that patients with AdHF may comprise up to 10% of the overall heart failure population, these benefits may be accessible to a substantial number of patients.
Bouchez and colleagues re-iterated the advice of the authors of the 2016 European Society of Cardiology (ESC) guidelines on acute and chronic heart failure, who recommend the use of levosimendan in cases where there is concomitant use of beta-blockers.
Levosimendan, both in the acute setting and in the repetitive/intermittent context of AdHF, appears to be a promising option to improve renal perfusion or to reverse or ameliorate renal dysfunction. However, further controlled trials are needed to confirm the status of levosimendan for this purpose. In particular, the authors emphasised the conclusions of Lannemyr et al. who recently suggested that levosimendan “could be the preferred inotropic agent for treatment of the cardiorenal syndrome”.
These are substantial attainments for any drug in these areas of heart failure therapy and they confirm levosimendan as a uniquely-configured resource for this field. Join us again in 2019 for the next chapters in the development of this remarkable agent.
Bouchez S, Fedele F, Giannakoulas G, Gustafsson F, Harjola VP, Karason K, et al. Levosimendan in acute and advanced heart failure: an expert perspective on posology and therapeutic application. Cardiovasc Drugs Ther. 2018;32(6):617–24.
Lannemyr L, Ricksten SE, Rundqvist B, Andersson B, Bartfay SE, Ljungman C, et al. Differential effects of levosimendan and dobutamine on glomerular filtration rate in patients with heart failure and renal impairment: a randomized double-blind controlled trial. J Am Heart Assoc. 2018;7:e008455.
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 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.
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.
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 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.