SPC365

Intermittent levosimendan in advanced palliative heart failure improves quality of life and reduces heart failure decompensations: a single center-experience

Session: SESSÃO DE POSTERS 30 - INSUFICIÊNCIA CARDÍACA CRÓNICA: TRATAMENTO
Speaker: Jéni Quintal

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; Tatiana Duarte; Sara Gonçalves; Ana Sousa; Crisálida Ferrreira; Patrícia Bernardes; Rui Antunes Coelho; Catarina Lagoas Pohle; David Campos; Marco Tomaz; Ermelinda Pedroso; Filipe Seixo

<p><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Background:</span></span></span></strong> <span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Levosimendan, with its unique pharmacological profile, offers prolonged inotropic effects and can be administered in an outpatient setting, making it a valuable option for advanced heart failure (AHF) patients not eligible for advanced therapies. Pulsed levosimendan infusion may improve symptoms and reduce hospitalizations, though evidence remains limited, warranting further research.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Purpose</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">This study aimed to assess the impact of intermittent levosimendan cycles on quality of life and outcomes in AHF patients, who are not candidates for advanced therapies, in an outpatient setting.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">We conducted a retrospective single-center cohort study, including AHF patients who were not candidates for advanced therapies, referred for intermittent intravenous administration of levosimendan in an outpatient setting between 1 July 2020 and 30 May 2024. Baseline and follow-up evaluations included clinical assessments, laboratory tests, and analysis of HF hospitalizations and HF decompensations. Outcomes were assessd at 6 months and 1 year post-initiation of levosimendan treatment. Statistical analyses were conducted with appropriate tests for data distribution.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Results:&nbsp;</span></span></span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">A total of 16 patients were included, with a mean age of 70 (&plusmn;12) years, 63.5% of whom were male. The most common etiologies for heart failure were ischemic cardiomyopathy (43.8%) and non-ischemic dilated cardiomyopathy (31.3%). The population had a high prevalence of cardiovascular risk factors, atrial fibrillation, and coronary artery disease. The median LVEF before levosimendan initiation was 30% (13-38%), with all patients in NYHA class III or higher.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Comparing the need for ICD shocks or therapies before and 6 months and 1 year after levosimendan, a significant reduction was observed (18.8% vs. 0% vs. 0%, p &lt; 0.001) - Table 1.&nbsp;NYHA classes and functional capacity (assessed by the 6-minute walk test) showed significant improvement over the course of levosimendan cycles (p &lt; 0.001 and p = 0.018, respectively). Additionally, levosimendan significantly reduced hospitalizations due to heart failure and unplanned day hospital visits for HF decompensations (p &lt; 0.001 and p = 0.051, respectively). There were no significant differences regarding NT-proBNP levels.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">After a median follow-up of 17 (1-37) months and an average of 6 (&plusmn;4) cycles, with an average duration of 18 (&plusmn;15) months, 7 deaths were verified.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Conclusions: </span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Our center&#39;s experience reinforces that intermittent levosimendan therapy in patients with advanced heart failure in the palliative phase not only enhances quality of life and functional capacity but also leads to a significant reduction in heart failure decompensations, hospitalizations, and the need for ICD therapies. These findings underscore its potential as a valuable therapeutic option in this patient population.</span></span></span></span></span></p>