July 2017 post
6/22/2017 1:19:06 PM
Heart failure is the leading cause of adult hospitalization in the industrialized world and imposes a substantial burden on the public health. The later stages of heart failure are characterized by a steady decline in quality of life and frequent re-hospitalization for recurrent acutization of the symptoms.1 Most of the re-hospitalizations take place relatively soon after discharge from the index hospitalization. About one quarter of patients are re-hospitalized within one month, and more than 60% of these re-hospitalizations are seen within 15 days after discharge.2
Several clinical studies have been performed on the repetitive use of intravenous levosimendan in Advanced Heart Failure.3 Their results are suggesting that repeated infusions of levosimendan bring advantages to patients with advanced chronic heart failure, both as it regards mortality4 and re-hospitalization.5 However, few of these studies were properly powered. Therefore, a larger study is needed to verify the favorable results.
In the newly commenced LEODOR study (www.leodortrial.com) the efficacy and safety of intermittent levosimendan therapy started during the vulnerable phase after a recent hospitalization for heart failure is tested. The hypothesis is that, compared with placebo, repetitive administration of levosimendan in the post-acute heart failure syndrome discharge period, will be associated with greater clinical stability through 14 weeks as assessed by a composite clinical endpoint consisting of mortality, acute heart failure episodes, and change in natriuretic peptide levels.
References: 1. Fruhwald S et al. Expert Rev Cardiovasc Ther. 2016;14:1335-1347. 2. Dharmarajan K et al. BMJ. 2013;347:f6571. 3. Pölzl G et al. Int J Cardiol 2017 [ePub May 23] doi: 10.1016/j.ijcard.2017.05.081. 4. Silvetti S & Nieminen MS. Int J Cardiol. 2016;202:138-43. 5. Silvetti S et al. ESC Heart Fail 2017 [ePub June 26].