Is Levosimendan Infusion Useful in Patients with Advanced Heart Failure? Meta-Analysis and Systematic Review

Background: Heart failure is a growing problem with a progressive increase in the number of patients as a result of better treatment outcomes and medical interventions. Patients with advanced heart failure who are not candidates for heart transplantation or left ventricular assist device become a major challenge for the health system, as they have a high mortality and hospitalization rate. Intermittent levosimendan infusion has been used in this group of patients even though the evidence is still controversial. Objective: The purpose of this study is to determine the efficacy of intermittent levosimendan infusion in patients with advanced heart failure. Methods: We conducted a systematic review of the literature on EMBASE, EPISTEMONIKOS, MEDLINE/Pubmed and Trip database until January 2018. We included published randomized clinical trials and meta-analysis without language restriction. Results: Eleven studies including 586 patients evaluating intermittent levosimendan infusions in patients with advanced heart failure were included for evaluation. After a follow up period between 3 and 12 months there was a 55% reduction in mortality Odds Ratio (OR) 0.45 CI 95% (0.26; 0.78. p<0.003), a reduction in natriuretic peptide levels and an improvement in left ventricular ejection fraction without a reduction in hospitalization rates. Conclusions: Intermittent levosimendan infusions in patients with advanced heart failure showed significant benefit in patients with advanced heart failure with mortality reduction becoming a promising alternative in the treatment of this group of patients.