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Can we predict mortality and readmission rate in Acute Heart Failure treated with Levosimendan?
Session:
Posters - D. Heart Failure
Speaker:
Gualter Santos Silva
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Gualter Santos Silva; Mariana Ribeiro da Silva; Pedro Gonçalves Teixeira; Pedro Ribeiro Queirós; Mariana Brandão; Diogo Ferreira; Eulália Pereira; Olga Sousa; Adelaide Dias; Daniel Caeiro; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p><u><strong>BACKGROUND:</strong></u> Acute heart failure is a complex clinical condition associated with high morbidity and mortality. Its treatment remains a therapeutic challenge, with inotropic agents playing an important role. Levosimendan (LVS) is distinguished from other catecholaminergic inotropic by its three mechanisms of action - inotropic, vasodilator and cardioprotection - and by the presence of a long-acting metabolite.</p> <p><u><strong>OBJECTIVE:</strong></u> We aimed to characterize the predictors of mortality and readmission rate following acute heart failure hospitalizations treated with LVS.</p> <p><u><strong>METHODS AND RESULTS:</strong></u> This is a retrospective analysis of all 69 patients treated with LVS between January 2015 and August 2019 in a Cardiology Department of a Tertiary Center (84% male, mean age 65 ± 13 years and mean left ventricular ejection fraction 27 ± 12%). 30-day and 6-month mortality was 23.2% and 36.2%, respectively. Risk factors for 30-day mortality (p<0.05) were: obesity (41% vs 17%), absence of valvular heart disease (48% vs 13%) and plasma creatinine (pCr) variation after LVS infusion (+0.05 mg/dL vs -0.24 mg/dL). Patients with ischemic heart disease have higher mortality at 6 months (68% vs 25%, p=0.001). Risk factors for both 30-day and 6-month mortality (p<0.05) were: chronic kidney disease stage ≥3 (40% vs 10%; 63% vs 15%), pCr before LSV (1.97 vs 1.43mg/dL; 1.83 vs 1.48mg/dL) and pCr after LVS (1.82 vs 1.23mg/dL; 1.71 vs 1.22mg/dL). The readmission rate at 30 days and 6 months was 7.4% and 36.0%, respectively. We did not find any significant predictors for 30-day readmission. Factors associated with higher readmission rate at 6 months (p<0.05) were: pre-infusion NYHA class IV (71% vs 30%), decompensated chronic HF (44% vs 9%) and atrial fibrillation or atrial flutter rhythm (56% vs 26%). In 27 cases, pre and post treatment NT-proBNP values were available. LVS therapy significantly reduced NT-proBNP from 10467 ± 8984 ng/L to 8237 ± 9500 ng/L (p=0.012) and improvement was observed in 93% of patients. Survival at 30 days and 6 months can be predicted by percentage of NT-proBNP improvement (-84.4% vs -28.4%, p=0.047; -92.3% vs -16.3%; p=0.012).</p> <p><u><strong>CONCLUSION:</strong></u> Acute heart failure patients requiring inotropic therapy have high mortality and readmission rates. Several clinical features and analytical response to Levosimendan perfusion are predictors of these events. Futhermore, Levosimendan significantly reduces NT-proBNP. The magnitude of this reduction is a predictor of short- and long-term mortality.</p>
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