Management of heart failure and the role of the new inotrope levosimendan

Despite the availability of an array of medical therapies for the treatment of heart failure, quality of life is often poor for the majority of patients, and the mortality remains high. In addition, treatment is regularly not well tolerated and this results in frequent hospital admissions for some patients. This article reviews the management and medical treatment of acute heart failure, focusing on the emerging role of levosimendan.
Levosimendan is currently licensed in 10 European countries (Simdax, Orion Pharma, Finland) for the treatment of acute heart failure. It is a new inotropic drug with a dual mechanism of action: sensitisation of the cardiac myofilament to calcium, thus enhancing cardiac contractility, and vasodilation of vascular smooth muscle. The published clinical studies so far have utilised intravenous levosimendan. However, the agent is also well absorbed orally, and phase two trials of its use in stable patients with less severe heart failure are underway.1