SPC365

Intermittent outpatient administration of levosimendan in patients with advanced heart failure: is it enough?

Session: Sessão de Posters 38 - Insuficiência cardíaca avançada
Speaker: Inês Gomes Campos

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.6 Chronic Heart Failure - Clinical
Session Type: Cartazes
FP Number: ---
Authors: Inês Gomes Campos; Rafaela G. Lopes; Mauro Moreira; Bruno Bragança; Isabel Cruz; Patricia Silva; Ana Neto; Inês Gonçalves; Aurora Andrade
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The number of patients with advanced heart failure (HF) is increasing and the access to long-term therapies such as heart transplantation and mechanical circulatory support is limited. Levosimendan, a calcium sensitizer agent with inodilator effects, has been shown to reduce NT-proBNP levels and acute HF hospitalizations in these patients. In this study, we aim to assess the role of levosimendan in this population, providing data from almost 400 infusions.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective observational study of consecutive advanced HF patients referred for intermittent outpatient levosimendan infusions between 2015 and 2023. It was administered by a 6-hour intravenous infusion in the maximal tolerated dose, every 2 weeks for at least 6 cycles, along with non-invasive electrocardiographic and haemodynamic monitoring. Clinical, laboratorial and echocardiographic data were collected from baseline and after the last infusion.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 26 patients were included (mean age 65<span style="font-family:Symbol">&plusmn;</span>7.9 years, 76.9% male), with a baseline mean LVEF 19.0<span style="font-family:Symbol">&plusmn;</span>5.6% and a median of 1 HF hospitalization in the previous 6 months. 24 patients (92.3%) were in NYHA functional class III at baseline, with a median NT-proBNP level of 4391pg/mL (IQR 7006).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 387 infusions were administered (median 9; IQR 16), mainly as a bridge for stabilization (80.8%) or for transplantation (19.2%). 13 patients (50.0%) had premature discontinuation, the majority due to HF hospitalization.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At the end of follow-up, there was a significant reduction (&gt;25%) in NT-proBNP levels in 13 patients (50.0%), in NYHA functional class in 10 patients (38.5%) and in diuretic dose in 6 patients (23.1%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Main adverse events reported were hypokalemia requiring supplementation in 19 patients (73.1%) and arterial hypotension in 15 patients (57.7%). It was reported an arrhythmic event (ventricular tachycardia) in 1 patient (3.8%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During follow-up, 1 patient underwent heart transplantation, 42.3% patients died from cardiovascular (CV) causes and 19.2% patients died from non-CV causes. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Intermittent outpatient administration of levosimendan is a strategy used in an attempt to stabilize a very sick population with poor prognosis. In these patients, levosimendan leads to transitory clinical relief with reductions in NYHA functional class and NT-proBNP levels. However, as demonstrated in this real-life registry, it cannot be seen as a destination therapy nor lead to the postponement of essential therapies such as mechanical circulatory support and heart transplantation, unfortunately with very limited availability in our country. There&rsquo;s a need for political and institutional measures that improve the availability and access of patients to those therapies.</span></span></span></p>