Levosimendán ambulatorio intermitente en pacientes ancianos con insuficiencia cardiaca avanzada: registro LEVO-D

Abstract

Introduction and objectives

Elderly patients with advanced heart failure (AHF) who are not candidates for advanced treatments have a poor prognosis. The objective of this study is to describe patterns of use and safety of intermittent ambulatory infusion of levosimendan in patients older than 75 years with AHF as a treatment option, compared to patients younger than 75 years.

Methods

A multicenter retrospective analysis was performed involving 23 tertiary hospitals (January 2015-September 2020). A total of 404 patients were enrolled (37% older than 75 years and 63% younger than 75 years). Patients had to be on optimal medical treatment. Patients with onset heart failure (HF) or patients undergoing any procedure that would improve prognosis after starting levosimendan were excluded.

Results

A Cox regression model showed that 1-year response (defined as absence of death, HF admission, or unplanned HF visit) did not differ between patients. Levosimendan administration had to be discontinued more frequently in patients older than 75 years due to lack of efficacy and side effects (40.7% discontinued), but this was not associated with an increase in implantable cardioverter-defibrillator therapy 1 year before and 1 year after drug administration.

Conclusions

The LEVO-D registry adds information to the current limited scientific evidence on the prognosis of elderly patients with AHF and suggests that levosimendan is a safe option that can reduce readmissions and emergency visits for HF.