June 2017 post
6/22/2017 1:17:17 PM
Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach.
In these settings, levosimendan has potential advantages over conventional inotropes such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life (see paper).
A panel of 45 expert clinicians from 12 European countries met to review the literature and envision an appropriately designed and properly powered clinical trial addressing these needs. A composite Global Rank Score was advocated as primary end-point where death, re-hospitalization, and change in N-terminal prohormone-brain natriuretic peptide level are considered in a hierarchical order (see previous FIGHT trial).