Outpatient 6-Hour Levosimendan Treatment as a Bridge to Heart Transplant

Heart transplantation is the treatment of choice for selected patients with advanced heart failure (HF), improving quality of life and conferring a survival benefit compared to conventional management. However, heart transplantation depends on a donor’s presence, necessitating bridge strategies. Infusion of inotropes was suggested as one of these treatments, but a meta-analysis of randomized trials found increased mortality with long-term inotropic support, and HF guidelines do not now endorse this strategy.

The inodilator Levosimendan has arisen as a treatment option: its inotropic action can continue for up to 2 weeks while being less pro-arrhythmic than traditional inotropes. It was traditionally administered as a 24-hour infusion. Nonetheless, a 24-hour infusion necessitates at least a two-day stay in the hospital. Recently, two randomized placebo-controlled, double-blind clinical trials evaluated 6-hour cycles of Levosimendan therapy in ambulatory patients with advanced HF and demonstrated that it reduces NT-proBNP levels and admissions for acute decompensated HF. ^,

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