Document Detail


Levosimendan vs. dobutamine: outcomes for acute heart failure patients on beta-blockers in SURVIVE.
MedLine Citation:
PMID:  19158152     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Alexandre Mebazaa; Markku S Nieminen; Gerasimos S Filippatos; John G Cleland; Jeffrey E Salon; Roopal Thakkar; Robert J Padley; Bidan Huang; Alain Cohen-Solal
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-01-21
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-02-20     Completed Date:  2009-05-12     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  304-11     Citation Subset:  IM    
Affiliation:
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
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adrenergic beta-Antagonists / therapeutic use*
Aged
Cardiotonic Agents / administration & dosage,  therapeutic use*
Cause of Death / trends
Dobutamine / administration & dosage,  therapeutic use*
Dose-Response Relationship, Drug
Double-Blind Method
Drug Therapy, Combination
Female
Follow-Up Studies
Heart Failure / drug therapy*,  mortality,  physiopathology
Humans
Hydrazones / administration & dosage,  therapeutic use*
Infusions, Intravenous
Male
Middle Aged
Pyridazines / administration & dosage,  therapeutic use*
Stroke Volume / drug effects
Survival Rate / trends
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 131741-08-7/simendan; 34368-04-2/Dobutamine
Comments/Corrections
Comment In:
Eur J Heart Fail. 2010 Aug;12(8):893   [PMID:  20675671 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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