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Reducing the Burden of Advanced Heart Failure: A Clinical and Economical Analysis of an Intermittent Levosimendan Programme
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 11 – AVANÇOS NA GESTÃO DA INSUFICIÊNCIA CARDÍACA
Speaker:
João Fernandes Pedro
Congress:
CPC 2025
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.3 Health Economics
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
Abstract
<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">: Advanced heart failure (HF) entails a high economic burden, mainly due to the frequent hospitalizations and emergency department (ER) visits that patients require. Previous studies suggest that intermittent levosimendan administrations (iLev) can reduce this economic burden by reducing HF-related admissions.</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">: To assess the impact of intermittent levosimendan treatment in the heart failure related economic burden in 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">: One-arm, prospective, single-center study of consecutive advanced heart failure patients receiving iLev at a tertiary hospital. The total number of HF-related hospitalizations and ER visits since iLev initiation and in the exact same time frame before iLev and the total number of iLev administrations, either as a 24-hour inpatient or a 6-hour outpatient administration were recorded. Cost analysis was based on standardized Ministry of Health rates for HF-related hospitalizations, ER visits and 6-hour day care hospital visits and the price of a levosimendan dose. Wilcoxon Signed-Rank Test was used for comparison</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">: Over a 6-year period, 283 levosimendan infusions were administered to 34 patients, including 142 inpatient 24-hour infusions and 141 outpatient infusions. The median age was 68 (IQR 63–73) years, and the median left ventricle ejection fraction was 24% (IQR 16–27%). The median follow-up 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">Within this time frame, the median number of admissions per patient before iLev was 4 (IQR 2-5) and after iLev, 2 (IQR1-3)The median number of ER visits before iLev was 5 (IQR 3-14) and 2 [IQR 1-5] after iLev. A significant reduction in both HF-related hospitalizations (p<0.001) and ER visits (p<0.001) after iLev initiation was observed. The mean cost per patient before treatment was €17,298.00 (IQR €8,957-23,696) and €10,682.50 (IQR €6,268-18,540) after iLev, representing a significant reduction in costs (p=0.010). In the deterministic analysis, the mean total savings per patient after starting iLev was - €4,112.76.</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 infusions in patients with advanced HF resulted in a reduction in heart failure related hospital admissions, emergency department visits and overall healthcare costs. These results suggest that intermittent Levosimendan administration may be cost-effective and may generate important savings when used in a well select population with advanced heart failure.</span></span></span></p>
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