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European Journal of Heart Failure Advance Access published online on January 21, 2009
European Journal of Heart Failure, doi:10.1093/eurjhf/hfn045
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Levosimendan vs. dobutamine: outcomes for acute heart failure patients on β-blockers in SURVIVE{dagger}

Alexandre Mebazaa1,*, Markku S. Nieminen2, Gerasimos S. Filippatos3, John G. Cleland4, Jeffrey E. Salon5, Roopal Thakkar5, Robert J. Padley5, Bidan Huang5 and Alain Cohen-Solal6

1 Department of Anaesthesiology and Critical Care Medicine, Hôpital Lariboisière, APHP; Université Paris 7 Paris Diderot; U 942 INSERM, 2 rue Ambroise-Paré, Paris Cedex 10 75475, France
2 Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
3 Department of Cardiology, Athens University Hospital, Athens, Greece
4 Department of Cardiology, University of Hull, Kingston-Upon-Hull, UK
5 Abbott Laboratories, Abbott Park, IL, USA
6 Department of Cardiology, Hôpital Lariboisière, APHP; Université Paris 7 Paris Diderot; U 942 INSERM, Paris, France

* Corresponding author. Tel: +33 1 49 95 80 72, Fax: +33 1 49 95 80 73, Email: alexandre.mebazaa{at}lrb.aphp.fr


  Abstract

Aims: Many chronic heart failure (CHF) patients take β-blockers. When such patients are hospitalized for decompensation, it remains unclear how ongoing β-blocker treatment will affect outcomes of acute inotrope therapy. We aimed to assess outcomes of SURVIVE patients who were on β-blocker therapy before receiving a single intravenous infusion of levosimendan or dobutamine.

Methods and results: Cox proportional hazard regression revealed all-cause mortality benefits of levosimendan treatment over dobutamine when the SURVIVE population was stratified according to baseline presence/absence of CHF history and use/non-use of β-blocker treatment at baseline. All-cause mortality was lower in the CHF/levosimendan group than in the CHF/dobutamine group, showing treatment differences by hazard ratio (HR) at days 5 (3.4 vs. 5.8%; HR, 0.58, CI 0.33–1.01, P = 0.05) and 14 (7.0 vs. 10.3%; HR, 0.67, CI 0.45–0.99, P = 0.045). For patients who used β-blockers (n = 669), mortality was significantly lower for levosimendan than dobutamine at day 5 (1.5 vs. 5.1% deaths; HR, 0.29; CI 0.11–0.78, P = 0.01).

Conclusion: Levosimendan may be better than dobutamine for treating patients with a history of CHF or those on β-blocker therapy when they are hospitalized with acute decompensations. These findings are preliminary but important for planning future studies.

Key Words: Levosimendan • Dobutamine • Heart failure, congestive • Cardiac output, low • β-blockers, adrenergic

Received June 2, 2008; Revised October 9, 2008; Accepted December 15, 2008

{dagger} See Appendix for list of investigative sites and principal investigators.


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