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Alexandre Mebazaa, Markku S. Nieminen, Gerasimos S. Filippatos, John G. Cleland, et al. have recently published a subanalysis of the big clinical trial SURVIVE (Levosimendan Versus Dobutamine: Outcomes for Acute Heart Failure Patients on β-blockers in SURVIVE) showing that in Heart Failure patients treated with beta-blockers (the mayority) levosimendan has benefits over dobutamine as regards the survival.

See their ABSTRACT: Background An increasing proportion of patients with chronic heart failure are on β-blocker therapy. Studies are needed to evaluate the interaction of β-blockers with inotropes on outcomes  when patients are hospitalised for the treatment of acute decompensation. Aim To address treatment responses of SURVIVE patients who were on -blocker therapy before the single intravenous infusion of levosimendan or dobutamine was given. Methods and results When the SURVIVE population was stratified according to the presence/absence of history of chronic heart failure (CHF) and use/non-use of β-blocker treatment at baseline benefits of levosimendan treatment over dobutamine for all-cause mortality were revealed by the Cox Proportional Hazard regression (post-hoc subset analyses). For patients with previous CHF, all-cause mortality was lower in the levosimendan group than in the dobutamine group, showing significant or trending treatment differences by hazard ratios at day 14 and day 31. For patients who used -blockers (n=669), mortality by treatment was also 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) and not at day 31 (7.1% vs 9.3% deaths; HR, 0.75; CI 0.44-1.27, p=0.29). Conclusion Levosimendan has benefits over dobutamine for treating patients with a history of CHF or those receiving B-Blocker therapy hospitalised with acute decompensated chronic heart failure