Efficacy and safety of intermittent intravenous outpatient administration of levosimendan in patients with advanced heart failure: the LION‐HEART multicentre randomised trial

Comín‐Colet, Josep; Manito, Nicolás; Segovia‐Cubero, Javier; Delgado, Juan; Pinilla, José Manuel García; Almenar, Luís; Crespo-Leiro, María G.; Sionís, Alessandro; Blasco, Teresa; Pascual-Figal, Domingo A.; González‐Vílchez, Francisco; Lambert-Rodríguez, José Luis; Grau, María; Bruguera, Jordi; Investigators, Lion-Heart Study

doi:10.1002/ejhf.1145

Cited by 143 publications

(152 citation statements)

References 18 publications

(36 reference statements)

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“…Patients randomized to levosimendan were also less likely to be hospitalized for heart failure or experience a decline in health‐related quality of life compared to placebo. Adverse events were similar between groups . More studies are needed to determine if this approach may be useful for patients with contraindications to transplantation or long‐term MCS.…”

Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 94%

“…While meta‐analyses of several heterogeneous small trials of a repeated infusion strategy have suggested a positive effect on survival and a reduction in hospitalizations, such a survival effect has not been demonstrated in a single, adequately sized, prospective study. The LION‐HEART pilot study randomized 69 patients with advanced heart failure to placebo or levosimendan 0.2 µg/kg/min over 6 h every 2 weeks for 12 weeks . NT‐proBNP over time, the primary endpoint, was significantly lower in the levosimendan group compared to the placebo group.…”

Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 99%

See 1 more Smart Citation

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

604

597

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This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

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Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 94%

Section: Management Strategies For Patients With Advanced Heart Failurementioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

604

597

View full text Add to dashboard Cite

show abstract

“…Adverse event rates were similar in the two treatment groups. These promising results can be the basis for a larger trial …”

Section: Clinical Trials Of Medical Therapymentioning

confidence: 85%

July 2018 at a glance: practical guidance in acute heart failure, pathophysiology and clinical trials of medical therapy

Metra

2018

European J of Heart Fail

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“…17 A meta-analysis has recently suggested that ambulatory infusions of inotropic agents may have favourable effects on symptoms with neutral effects on mortality. 83 Currently, routine use of ultrafiltration is not recommended and should be limited to patients who fail to respond to diuretics. 81,82 In recent trial, intermittent administration of intravenous levosimendan lowered NT-proBNP levels, primary endpoint of the trial, reduced HF hospitalization and improved the quality of life in 69 outpatients with advanced chronic HF.…”

Section: Other Optionsmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Efficacy and safety of intermittent intravenous outpatient administration of levosimendan in patients with advanced heart failure: the LION‐HEART multicentre randomised trial

Cited by 143 publications

References 18 publications

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

July 2018 at a glance: practical guidance in acute heart failure, pathophysiology and clinical trials of medical therapy

Highlights in heart failure

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