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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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32. Cardiovascular Nursing
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6-hours Levosimendan outpatient administration in advanced heart failure: 93 sessions experience
Session:
Painel 2- Insuficiencia cardiaca 4
Speaker:
António Valentim Gonçalves
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
António Valentim Gonçalves; Tiago Pereira Da Silva; Rui M. Soares; João Pedro Reis; Rita Ilhão Moreira; Isabel Gonçalves Machado Cardoso; André Grazina; Ana Teresa Timóteo; Rui Cruz Ferreira
Abstract
<p><strong>Introduction</strong></p> <p>Advanced Heart Failure (HF) is defined by the presence of objective evidence of cardiac dysfunction and poor functional capacity leading to recurrent episodes of hospitalisations. The safety and benefit of intermittent 6-hours administration of Levosimendan to ambulatory patients was first studied in the LevoRep and LION-HEART trials but clinical experience with outpatient Levosimendan treatment is lacking.</p> <p> </p> <p><strong>Purpose</strong></p> <p>Present our 1-year experience performing 6-hours Levosimendan in an outpatient care for advanced HF patients.</p> <p> </p> <p><strong>Methods</strong></p> <p>Patients with advanced HF despite optimal medical management and device therapy were selected to start 6-hours Levosimendan in an outpatient care.</p> <p>Advanced HF was defined by persistent ambulatory NYHA functional class III or IV, left ventricular ejection fraction (LVEF) inferior to 40% and hospitalizations for pulmonary and/or systemic congestion requiring intravenous administration of diuretics or low-output state requiring inotropic support in the previous 12 months.</p> <p>Levosimendan was performed as a 6-hour intravenous infusion (0.2 ??g/kg/min, without bolus) every two weeks in an outpatient setting that allowed non-invasive monitoring of vital signs.</p> <p> </p> <p><strong>Results</strong></p> <p>Levosimendan 6-hours treatment was started in 13 patients for a total of 93 sessions. Baseline characteristics are presented in the table 1. Mean age was 60 ± 15 years, with a mean LVEF of 26 ± 7.</p> <p>All the patients had at least 1 HF hospitalization in the previous year and there were a total of 21 HF hospitalization in the 3 months previous to start Levosimendan outpatient treatment, showing a high-risk population despite optimal medical management.</p> <p>There are no adverse events to report in the 93 sessions. One patient performed only 1 session, since he presented with symptoms of diarrhea after a long hospitalization with previous need for antibiotic treatment. This patient was hospitalized with the diagnosis of C. difficile infection with an evolution in cardiac shock and death during this hospitalization. This is the only death in this group of patients.</p> <p>During a mean follow-up time of 149 ± 144 days only one additional patient, who was already waiting for a LVAD implantation prior to Levosimendan treatment, required one HF hospitalization for persisting systemic congestion treated with the onset of peritoneal dialysis. In the group of three patients in the waiting list for heart transplantation, two were successfully performed during the follow-up and one was withdrawn because of pVO<sub>2</sub> improvement (12.1-23.7 ml/kg/min).</p> <p> </p> <p><strong>Conclusion</strong></p> <p>Larger studies are needed to confirm the safety and efficacy of this therapeutic strategy and its effect on clinical and patient-reported outcomes. However, our results show that Levosimendan 6-hours outpatient administration is safe and related to a reduction in HF hospitalizations, encouraging us to extend this outpatient treatment strategy.</p>
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