Key result
Levosimendan cuts 30-day mortality ~47% vs. dobutamine in low-output ADHF.
Why the study?
The survival impact of dobutamine in acute decompensated heart failure with reduced ejection fraction remains uncertain, while levosimendan may offer haemodynamic and clinical advantages over catecholaminergic inotropes.
Does intravenous levosimendan reduce 30-day all-cause mortality compared with dobutamine in adults with acute decompensated heart failure and LVEF <40% requiring inotropic support?
Meta-Analysis (n=1,973)
Does intravenous levosimendan reduce 30-day all-cause mortality compared with dobutamine in adults with acute decompensated heart failure and LVEF <40% requiring inotropic support?
In adults with ADHF and low cardiac output (LVEF <40%), levosimendan was associated with significantly lower 30-day mortality and shorter hospital stay compared with dobutamine.
Supports levosimendan over dobutamine for 30-day survival in low-output ADHF; confirms mortality benefit across eight RCTs.
Background Acute decompensated heart failure (ADHF) with reduced ejection fraction frequently requires inotropic support. Dobutamine is widely used, but its impact on survival remains uncertain. Levosimendan, a calcium sensitiser with vasodilatory properties, may offer haemodynamic and clinical advantages over catecholaminergic inotropes. Purpose To compare the effects of levosimendan versus dobutamine on short-term clinical outcomes in adults with ADHF and low cardiac output. Methods We systematically searched MEDLINE, Embase and Cochrane Library from inception to 3 December 2024 for randomised controlled trials enrolling adults with ADHF or postoperative low cardiac output syndrome and left ventricular ejection fraction <40% requiring intravenous inotropes. Trials comparing levosimendan with dobutamine and reporting at least one outcome of interest were included. The primary outcome was 30-day all-cause mortality; secondary outcomes were length of hospital stay and renal function. Random-effects meta-analyses were performed, and risk of bias was assessed with RoB 2. Certainty of evidence was graded with GRADE. Results Eight trials including 1973 patients (995 levosimendan, 978 dobutamine) met the criteria. Levosimendan significantly reduced 30-day mortality compared with dobutamine (OR 0.53, 95% CI 0.31–0.91; I²=27%). In four trials (n=325), levosimendan shortened hospital stay by a mean of 2.4 days (95% CI −3.33 to −1.47; I²=79%). Two studies reported renal outcomes, showing greater improvements in estimated glomerular filtration rate and reductions in serum creatinine with levosimendan. Certainty of evidence was moderate for mortality and very low for hospital stay. Conclusion In adults with ADHF and low cardiac output, levosimendan was associated with lower short-term mortality and shorter hospital stay compared with dobutamine, with signals of renal benefit. Larger contemporary trials are needed to confirm these findings and to define the optimal use of levosimendan in this high-risk population.
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Parente et al. (2026) conducted a meta-analysis in Acute decompensated heart failure or postoperative low cardiac output syndrome with reduced ejection fraction (n=1,973). Levosimendan vs. Dobutamine was evaluated on 30-day all-cause mortality (OR 0.53, 95% CI 0.31-0.91). Levosimendan significantly reduced 30-day all-cause mortality compared with dobutamine in adults with ADHF and low cardiac output (OR 0.53; 95% CI 0.31-0.91).
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