Ambulatory levosimendan administration in advanced heart failure: results from a single-center registry
J Van Loock, J Stassen, P J TimmermansAbstract
Background
Levosimendan, a calcium sensitizer, improves cardiac contractility without increasing myocardial oxygen consumption and promotes peripheral vasodilation. It is mainly used for cardiogenic shock in the ICU setting. The LION-HEART trial demonstrated that regular ambulatory levosimendan infusions also seem to be effective in patients with advanced chronic heart failure by reducing heart failure hospitalizations and improving NT-proBNP levels. However, data in these patients remains scarce and therefore, a national preference to use continuous infusion of dobutamine remains with inherent impediment of physical motion.
Purpose
To evaluate the safety, efficacy, and clinical outcomes of ambulatory levosimendan administration on a standard ward (non-ICU/CCU setting) in patients with advanced heart failure.
Methods
A single center, retrospective, observational study including patients with advanced heart failure who underwent at least one administration of levosimendan was performed. Sixteen patients, treated between 2024 and 2025, were identified for analysis (table 1). These patients received levosimendan infusions (0.2μg/kg/min for 6 hours) every 2 weeks in 12-week cycles. Data was extracted from electronic medical records. Primary endpoints are changes in biomarkers related to heart failure, namely the evolution in serum creatinine and NT-proBNP, during the administrations of levosimendan. The change was calculated between baseline (1st administration), halfway (4th administration) and day of the 6th administration. Secondary endpoints included: evolution in echocardiographic signs of congestive heart failure, repeated treatment cycles (as a surrogate marker for impact on quality of life), as well as safety and prevalence of clinical endpoints (death, heart transplant, hemodialysis initiation, or LVAD implantation).
Results
Sixteen patients completed at least one levosimendan administration on a standard ward. No adverse events were observed during the administration. Most patients (n=7 out of 9), who had not yet reached a clinical endpoint, opted for repeated treatment cycles, suggesting perceived beneficial effects on quality of life. Serial NT-proBNP and creatinine measurements demonstrated a promising downward trend (figure 1), though additional data is required for definitive conclusions. Seven patients reached a clinical endpoint. Administration of levosimendan on a standard ward proved safe as no adverse events or complications attributable to the non-critical care setting were reported.
Conclusion
This real-world experience demonstrates that ambulatory levosimendan administration is safe in a standard ward setting, supporting broader clinical accessibility. The high rate of repeated treatment cycles and favorable biochemical trends suggest beneficial effects on quality of life. These findings warrant larger prospective studies to establish the role of levosimendan in standard ward-based heart failure management.NT-proBNP and creatinine evolutionFor image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.