Are new approaches to rescue therapy for decompensated CHF possible? Challenges of evaluating endpoints
Urgency. Circulatory decompensation remains the most life-threatening complication of CHF, which requires rescue therapy. New approaches to the treatment of decompensated heart failure (DHF), which would influence the prognosis of patient, are presently the most urgent. Aim. To develop and test in clinical practice new approaches to the treatment of circulatory decompensation based on control of heart rate and inotropic support. Materials and methods. A one-center, pilot, randomized study on the clinical efficiency of the levosimendan and ivabradin combination in 41 patients with decompensated CHF. Duration of hospitalization, mortality, pulmonary artery wedge pressure (PAWP), coronary artery perfusion pressure (CAPP), blood level of NT-proBNP and clinical condition by CCS were evaluated. Results. We failed influencing the future frequency of hospitalizations using the acute period therapy. Nevertheless we achieved a maximum reduction of the risk for unfavorable outcomes in patients with acute phase of DHF using new approaches to correction and the earliest possible stabilization of hemodynamics.