Repetitive use of levosimendan for treatment of chronic advanced heart failure: clinical evidence, practical considerations, and perspectives: an expert panel consensus.
BACKGROUND
The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan.


RESULTS
A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience.


CONCLUSIONS
The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
Helsinki University Hospital, Helsinki, Finland. Electronic address: markku.nieminen@hus.fi.
M S
MS
Nieminen
Pensionsversicherungsanstalt SKA-RZ Großgmain für Herz-Kreislauf- und neurologische Erkrankungen, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversitaet, Großgmain, Austria.
J
J
Altenberger
Heart Failure Unit and Heart Transplant Clinic, Rabin Medical Center, Petah Tikva, Israel.
T
T
Ben-Gal
LK Krems, Abteilung für Innere Medizin mit kardiologischem Schwerpunkt, Krems, Austria.
A
A
Böhmer
Heart Failure Program, Cardiology Department, Hospital del Mar, Barcelona, Spain.
J
J
Comin-Colet
Stavanger University Hospital, University of Bergen, Stavanger, Norway.
K
K
Dickstein
Institute of Cardiology, Medical and Health Center, University of Debrecen, Debrecen, Hungary.
I
I
Edes
Department of Cardiovascular, Respiratory, Nephrology and Geriatric Sciences, 'La Sapienza' University of Rome, Rome, Italy.
F
F
Fedele
Heart Failure Unit, Hospital S. Francisco Xavier/CHLO, Faculdade de Ciências Médicas Universidade Nova de Lisboa, Lisbon, Portugal;
C
C
Fonseca
Department of Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Sta. Cruz de Tenerife, Spain.
M J
MJ
García-González
Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
G
G
Giannakoulas
Emergency Cardiology Services, Cardiac Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Z
Z
Iakobishvili
Heart Center, Kuopio University Hospital, Kuopio, Finland.
P
P
Jääskeläinen
Cardiology Clinic of the Gennimatas General Hospital of Athens, Athens, Greece.
A
A
Karavidas
Institut klinické a experimentální medicíny klinika kardiologie IKEM, oddělení akutní kardiologie KK IKEM, Vídeňská, Prague, Czech Republic.
J
J
Kettner
Orion Pharma, Espoo, Finland.
M
M
Kivikko
Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
L H
LH
Lund
Scientific Centre of Cardiovascular Surgery of Bakulev, Moscow, Russia.
S T
ST
Matskeplishvili
Cardiology Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
M
M
Metra
Department of Cardiovascular Science, University of Insubria, Circolo Hospital and Macchi Foundation, Varese, Italy.
F
F
Morandi
'A. De Gasperis' Cardiac Failure and Transplantology Department, Niguarda Ca'Granda Hospital Milan, Milan, Italy.
F
F
Oliva
Strazhesko Institute of Cardiology, National Scientific Centre, Kiev, Ukraine.
A
A
Parkhomenko
Second Cardiology Department and Heart Failure Unit, Attikon Teaching Hospital, Athens, Greece.
J
J
Parissis
Orion Pharma, Espoo, Finland.
P
P
Pollesello
Department of Internal Medicine III, University of Innsbruck, Austria.
G
G
Pölzl
Medizinische Klinik II, Klinikum Weiden, Akademisches Lehrkrankenhaus der Universität Regensburg, Germany.
R H G
RH
Schwinger
Unidad de Insuficiencia Cardiaca, Trasplante e Hipertensión Pulmonar, So. Cardiología, Hospital Univ. Puerta de Hierro, Madrid, Spain.
J
J
Segovia
Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany.
M
M
Seidel
Clinical Department of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia.
B
B
Vrtovec
Cardiology, Institute of Medical Sciences, Uppsala University, Uppsala, Sweden.
G
G
Wikström
D002908:Chronic Disease; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D011724:Pyridazines / Q000008:administration & dosage*; D012720:Severity of Illness Index; D000077464:Simendan; D014665:Vasodilator Agents / Q000008:administration & dosage*
D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan
Chronic advanced heart failure; Levosimendan; Repetitive inodilator therapy