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Levosimendan vs. dobutamine: outcomes for acute heart failure patients on β‐blockers in SURVIVE †
Author(s) -
Mebazaa Alexandre,
Nieminen Markku S.,
Filippatos Gerasimos S.,
Cleland John G.,
Salon Jeffrey E.,
Thakkar Roopal,
Padley Robert J.,
Huang Bidan,
CohenSolal Alain
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfn045
Subject(s) - levosimendan , medicine , dobutamine , heart failure , hazard ratio , cardiology , inotrope , decompensation , population , beta blocker , hemodynamics , confidence interval , environmental health
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.