Clinical Trials in Acute Decompensated Heart Failure—Over 50 Years of Research

2011 ◽  
Vol 7 (4) ◽  
pp. xv-xvii ◽  
Author(s):  
Christopher M. O’Connor ◽  
Mona Fiuzat
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

Levosimendan: A Novel Inotropic Agent for Treatment of Acute, Decompensated Heart Failure

2005 ◽  
Vol 39 (11) ◽  
pp. 1888-1896 ◽  
Author(s):  
Grace L Earl ◽  
James T Fitzpatrick
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Mortality Data ◽  
Pharmacokinetic Studies ◽  
Dependent Manner ◽  
Term Survival ◽  
Calcium Sensitizer

OBJECTIVE To review the literature on a novel calcium sensitizer, levosimendan. DATA SOURCES Articles were identified through searches of MEDLINE (1966–June 2005), International Pharmaceutical Abstracts (1970–June 2005), and EMBASE (1992–June 2005) using the key words levosimendan, simendan, calcium sensitizer, calcium sensitiser, and congestive heart failure. STUDY SELECTION AND DATA EXTRACTION Clinical trials and pharmacokinetic studies evaluating the safety and efficacy of levosimendan were selected. DATA SYNTHESIS Levosimendan 6–24 μg/kg intravenous bolus followed by a 24-hour continuous infusion of 0.05—0.2 μg/kg/min improved cardiac output and reduced pulmonary capillary wedge pressure in a dose-dependent manner. Dose-ranging and randomized clinical trials have demonstrated improvement in symptoms and hemodynamics and short-term survival outcomes in the treatment of acute, decompensated heart failure. Clinical trials evaluating retrospective mortality data and combined endpoints (mortality, rehospitalization) have demonstrated better outcomes with levosimendan compared with dobutamine. The incidence of hypotension with levosimendan is not significantly different than with dobutamine, but there is a dose-related increase in heart rate. CONCLUSIONS Levosimendan is useful in moderate to severe low-output heart failure in patients who have failed to respond to diuretics and vasodilators. Based on current studies, levosimendan appears to be a safe alternative to dobutamine for treatment of acute, decompensated heart failure. Prospective clinical trials are needed to confirm the effect of levosimendan on long-term survival and its role in heart failure in the setting of myocardial infarction.

Medical Therapy for Acute Decompensated Heart Failure: What Recent Clinical Trials Have Taught Us About Diuretics and Vasodilators

2011 ◽  
Vol 9 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Catherine Marti ◽  
Robert Cole ◽  
Andreas Kalogeropoulos ◽  
Vasiliki Georgiopoulou ◽  
Javed Butler
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Medical Therapy ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

Ultrafiltration versus intravenous loop diuretics in patients with acute decompensated heart failure: a meta-analysis of clinical trials

2017 ◽  
Vol 72 (2) ◽  
pp. 132-141 ◽  
Author(s):  
Mohamad Kabach ◽  
Hassan Alkhawam ◽  
Sachil Shah ◽  
Georges Joseph ◽  
Elie M. Donath ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure ◽  
Loop Diuretics

Assessing Acute Decompensated Heart Failure – Strategies and Tools

2012 ◽  
Vol 8 (2) ◽  
pp. 128
Author(s):  
Ali Vazir ◽  
Martin R Cowie ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Pulse Contour Analysis ◽  
Decompensated Heart Failure ◽  
Rapid Onset ◽  
Clinical Syndrome ◽  
Response To Therapy ◽  
Contour Analysis ◽  
Physiological Variables ◽  
Co Morbidity

Acute heart failure – the rapid onset of, or change in, signs and/or symptoms of heart failure requiring urgent treatment – is a serious clinical syndrome, associated with high mortality and healthcare costs. History, physical examination and early 2D and Doppler echocardiography are crucial to the proper assessment of patients, and will help determine the appropriate monitoring and management strategy. Most patients are elderly and have considerable co-morbidity. Clinical assessment is key to monitoring progress, but a number of clinical techniques – including simple Doppler and echocardiographic tools, pulse contour analysis and impedance cardiography – can help assess the response to therapy. A pulmonary artery catheter is not a routine monitoring tool, but can be very useful in patients with complex physiology, in those who fail to respond to therapy as would be anticipated, or in those being considered for mechanical intervention. As yet, the serial measurement of plasma natriuretic peptides is of limited value, but it does have a role in diagnosis and prognostication. Increasingly, the remote monitoring of physiological variables by completely implanted devices is possible, but the place of such technology in clinical practice is yet to be clearly established.

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