SPC365

Intermittent Levosimendan and Survival Outcomes in Advanced Heart Failure: A Real-World, Single-Centre Study

Session: SESSÃO DE COMUNICAÇÕES ORAIS 11 – AVANÇOS NA GESTÃO DA INSUFICIÊNCIA CARDÍACA
Speaker: João Fernandes Pedro

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: João Fernandes Pedro; Catarina Gregório; Ana Abrantes; Fátima Salazar; Ana Francês; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto J. Pinto; Dulce Brito; João R. Agostinho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Introduction</span></strong><span style="font-size:12.0pt">: Previous studies suggest that intermittent levosimendan administration (iLev) in patients with advanced heart failure (HF) may be associated with a reduction in HF admissions, however its impact on survival is still not well established. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Purpose</span></strong><span style="font-size:12.0pt">: The aim of this study was to evaluate the prognostic impact of intermittent levosimendan administration in a cohort of patients with advanced heart failure. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Methods</span></strong><span style="font-size:12.0pt">: Single-center, prospective, one-arm study of consecutive advanced HF patients who received iLev therapy at a tertiary hospital. The total number of HF admissions after iLev initiation was compared to the number of HF admissions that occurred in the exact same time period before starting iLev for each patient. The impact of iLev in survival was assessed by comparing the predicted life expectancy (PLE) at baseline estimated by the Seattle Heart Failure Model (SHFM) with the observed survival. For patients that have not surpassed their PLE nor died at the end of follow-up, a PLE recalculation was performed and the PLE difference was used to evaluate the survival benefit. Left ventricle (LV) assist device implant and heart transplant dates were considered the end of follow-up in patients that undergone these procedures.&nbsp; Wilcoxon test, Kaplan-Meier and Cox regression analyses were used to assess the prognostic impact of iLev.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Results</span></strong><span style="font-size:12.0pt">: The study included 34 advanced HF patients - 79.4% male; median age of 68 (IQR 63-73) years; baseline LV ejection fraction of 24% (IQR 16%-27%); mostly in NYHA Class III (82.4%). The median follow-up time was 1,3 years (IQR 0,7-2,7 years).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">Of these, 35.3% surpassed their PLE, 32.4% died before reaching it and 32.3% were still alive but had not yet reached it.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">The median PLE determined by the SHFM at baseline was 30.5 (IQR 21-44) months and the observed survival or recalculated PLE at the end of follow-up was 39.5 (IQR 11-54,25) months.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">Survival analysis demonstrated that patients receiving iLev had a significantly better survival probability when compared to their baseline predicted survival (HR 0.409; 95% CI 0.224&ndash;0.747; p=0.004) &ndash; Figure 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="font-size:12.0pt">iLev was also associated with a reduction in the total number of HF admissions: 4 admissions/patient/year before iLev Vs.<em>&nbsp;</em>2 HF admissions/patient/year (p&lt;0,001).&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong><span style="font-size:12.0pt">Conclusion</span></strong><span style="font-size:12.0pt">: Intermittent levosimendan administration may be associated with improved survival and with a reduction in HF admissions in advanced HF patients, highlighting its role as a supporting therapy in a particular subset of patients with highly complex clinical needs and a lack of readily available effective therapeutic options.</span></span></span></p>