Format

Send to

Choose Destination
Eur J Heart Fail. 2009 Mar;11(3):304-11. doi: 10.1093/eurjhf/hfn045. Epub 2009 Jan 21.

Levosimendan vs. dobutamine: outcomes for acute heart failure patients on beta-blockers in SURVIVE.

Author information

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. alexandre.mebazaa@lrb.aphp.fr

Abstract

AIMS:

Many chronic heart failure (CHF) patients take beta-blockers. When such patients are hospitalized for decompensation, it remains unclear how ongoing beta-blocker treatment will affect outcomes of acute inotrope therapy. We aimed to assess outcomes of SURVIVE patients who were on beta-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 beta-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 beta-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 beta-blocker therapy when they are hospitalized with acute decompensations. These findings are preliminary but important for planning future studies.

PMID:
19158152
PMCID:
PMC2645051
DOI:
10.1093/eurjhf/hfn045
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center