Assessment of quality of life using three activity questionnaires in heart failure patients after monthly, intermittent administration of levosimendan during a six-month period.

Introduction: Quality of life (QOL) in heart failure patients is severely compromised by the symptoms of the disease. Acute administration of levosimendan improves patients' symptoms for intervals of 7-10 days. The aim of this study was to assess the QOL in heart failure patients, after monthly, intermittent administration of levosimendan for a 6-month period, using 3 activity questionnaires: Specific Activity Questionnaire (SAQ), Left Ventricular Dysfunction 36 (LVD 36), and Minnesota Living with Heart Failure Questionnaire (LIhFE).

Methods: We prospectively studied 20 patients, age 61.0 +/- 15.7 years (mean +/- SD) with heart failure (NYHA III and IV). Levosimendan was administered intravenously for 24 hours (dose 0.1 mg/kg/min), 1 day every month for a 6-month period. Patients were asked to answer the questions of the 3 activity questionnaires SAQ, LVD36 and LIhFE before and after the end of the 6-month period.

Results: For the LIhFE (the best score is 0 and the worst 105) before levosimendan the score was 35.4 +/- 18.6 and after 6 months 22.2 +/- 13.0 (p<0.0001). SAQ (worst score is 0 and the best is 9) before levosimendan was 4.2 +/- 1.6 and after 6 months 4.7 +/- 1.3 (p<0.05). For the LVD36 (more ;right' answers, more severe condition) before levosimendan values were 52.6 +/- 26.2 and after 6 months 27.4 +/- 17.3 (p<0.0001). Before levosimendan patients had a mean left ventricular ejection fraction (LVEF) 30.3 +/- 6.9, while after 6 months the LVEF was 32.1 +/- 7.4 (p=0.01).

Conclusions: Levosimendan treatment improved both objective echocardiographic measurements and the subjective QOL questionnaires. LIhFE and LVD36 show a significant improvement in QOL in heart failure patients after a 6-month period of monthly intermittent administration of levosimendan. The SAQ showed a very small improvement, because it describes more strenuous activity, a situation unusual for these patients, who are severely symptom limited.