Intermittent levosimendan in advanced heart failure significantly reduced rehospitalizations at 3 months (16% vs 35%; RR 0.40; 95% CI 0.27-0.59; P<0.001).
Meta-Analysis (n=319)
Does intermittent levosimendan administration reduce rehospitalization in patients with advanced heart failure?
Intermittent levosimendan administration in advanced heart failure is associated with a significant reduction in rehospitalization rates at 3 months.
Effect estimate: RR 0.40 (95% CI 0.27-0.59)
Absolute Event Rate: 16% vs 35%
p-value: p=<0.001
Abstract Aims Intermittent levosimendan administration has been suggested to improve survival in patients with advanced heart failure (AdHF). Quality of life is a key issue for AdHF patients and is negatively affected by frequent hospitalizations. Methods and results CENTRAL, Google Scholar, MEDLINE/PubMed, Scopus, and the Cochrane Central Register of clinical trials (updated 15/1/2017) were searched for randomized controlled trials investigating the effect of intermittent levosimendan administration in patients with AdHF. The primary outcome was the number of patients requiring rehospitalization 3 months after the end of treatment. A total of 319 patients from six trials were included. Overall pooled analysis showed that the use of levosimendan was associated with a significant reduction in the number of rehospitalizations at 3 months: 33/207 (16%) vs. 39/113 (35%), risk ratio 0.40, 95% confidence interval 0.27–0.59, P 0.001, I2 = 0%. This result was confirmed by sensitivity analyses. Conclusions Within the limitations of this meta-analysis including also studies in which endpoints were not independently adjudicated and not clearly specified, repetitive or intermittent administration of levosimendan for patients with AdHF was associated with a reduction in the rehospitalization rate at 3 months. Large, high-quality randomized controlled trials are needed to confirm this finding.
Silvetti et al. (Thu,) conducted a meta-analysis in advanced heart failure (n=319). Intermittent levosimendan vs. Control was evaluated on number of patients requiring rehospitalization 3 months after the end of treatment (RR 0.40, 95% CI 0.27-0.59, p=<0.001). Intermittent levosimendan in advanced heart failure significantly reduced rehospitalizations at 3 months (16% vs 35%; RR 0.40; 95% CI 0.27-0.59; P<0.001).