Effect of baseline characteristics on mortality in the SURVIVE trial on the effect of levosimendan vs dobutamine in acute heart failure: Sub-analysis of the Finnish patients.
BACKGROUND
In the SURVIVE trial, including 1327 acute heart failure patients, no statistically significant difference between levosimendan and dobutamine in the 180-day all-cause mortality was seen. Country-specific differences in outcome were, however, present. In the Finnish sub-population in fact, mortality was significantly lower in levosimendan treated patients. We aim to understand the reasons for this disparity.


METHODS
The risk factors for all-cause mortality were identified in the whole study population using multivariate Cox proportional hazards regression analysis. Those factors were evaluated in the 95 patients of the Finnish sub-population.


RESULTS
The treatment by country interaction for mortality in Finland vs. other countries was significant, p=0.029. Levosimendan treated patients had a lower 180-day mortality compared to dobutamine treated (17% vs. 40%, p=0.023) in the Finnish sub-population. Baseline variables predicting survival in the whole SURVIVE trial population included age, systolic blood pressure, heart rate, myocardial infarction during admission, levels of NT-pro-BNP, glucose, creatinine, and alanine transferase, use of ACE inhibitors and β-blockers, oliguria, time from hospital admission to randomization, history of cardiac arrest, and left ventricular ejection fraction. Finnish patients were more frequently treated with β-blockers (88% vs. 52%, p<0.0001), their study treatment was started earlier (mean±SD 41±40h vs. 81±154; p<0.0001), and they had more often acute myocardial infarction at admission (39% vs. 16%, p<0.0001).


CONCLUSIONS
The lower mortality in the Finnish patients treated with levosimendan was associated with higher use of β-blockers, higher frequency of myocardial infarction at admission, and shorter delay between randomization and start of treatment.
Orion Pharma, Critical Care, Espoo, Finland.
Matti
M
Kivikko
Orion Pharma, Critical Care, Espoo, Finland.
Piero
P
Pollesello
Helsinki University Hospital, Helsinki, Finland.
Tuukka
T
Tarvasmäki
Orion Pharma, Critical Care, Espoo, Finland.
Toni
T
Sarapohja
Helsinki University Hospital, Helsinki, Finland. Electronic address: markku.nieminen@hus.fi.
Markku S
MS
Nieminen
Helsinki University Hospital, Helsinki, Finland.
Veli-Pekka
VP
Harjola
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D004280:Dobutamine / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011724:Pyridazines / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D000077464:Simendan; D016019:Survival Analysis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine
Acute heart failure; Clinical trial subanalysis; Dobutamine; Inotropes; Levosimendan; Mortality