Background Levosimendan is a positive inotropic drug that was approved in our country for the short term treatment of acute decompensation in chronic heart failure in situations where conventional treatment is not sufficient. There are few studies on off-label levosimendan use.
Purpose To analyse the use of levosimendan in medical and surgical patients assigned to cardiology and surgery cardiac care units.
Material and methods Descriptive observational study from January to December 2014 in a general teaching hospital with 717 functioning beds. All patients who received levosimendan infusion were included. The following variables were recorded: age, gender, indication, type of patient, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), creatinine clearance (CrCl) by Cockcroft-Gault and death from any cause during the study period. The medical records were reviewed by the computer application Clinical Records v.5.41
Results 145 patients were included (29% female, 71% male), average age 68.5 ± 11.3 years. 46 patients were medical (31.7%) and 99 were surgical (68.3%).
In the 46 medical patients, 33 received authorised use of levosimendan infusion; 24 with NYHA III and 9 with NYHA IV. Only 13 patients on the waiting list used levosimendan for its off-label use. Average LVEF was 26% and in 34/46 cases LVEF was <35%.
In the 99 surgically treated patients, the main indications were post-surgery low output cardiac syndrome (92%), cardiogenic shock (7%) and right ventricular failure (1%). 19 patients died during the study (19%).
In this group, 20% of patients had Clcr <30 mL/min. Thus the use of levosimendan was contraindicated in these cases of renal failure.
Conclusion Levosimendan is used according to the label indications in most patients and only off-label use was found for patients on waiting lists for heart transplants. In our study, the majority of uses of levosimendan were in patients after cardiac surgery where one of the most common complications is postoperative renal failure.
No conflict of interest.
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