title: Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations.
abstract: The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.
authors: a Department of Anesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine , Medical University of Graz , Graz , Austria.
authors: Sonja
authors: S
authors: Fruhwald
authors: b Critical Care Proprietary Products , Orion Pharma , Espoo , Finland.
authors: Piero
authors: P
authors: Pollesello
authors: c Department of Internal Medicine, Division of Cardiology , Medical University of Graz , Graz , Austria.
authors: Friedrich
authors: F
authors: Fruhwald
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D011724:Pyridazines / Q000627:therapeutic use*; D011788:Quality of Life; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Heart failure; ethics; inodilator; kidney function; levosimendan; palliative care; quality of life