IRCCS San Raffaele Scientific Institute, Milan, Italy.
Orion Pharma, Espoo, Finland.
ESC Heart Fail. 2017 Nov;4(4):595-604. doi: 10.1002/ehf2.12177. Epub 2017 Jun 29.
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.
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, I = 0%. This result was confirmed by sensitivity analyses.
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.
间歇性左西孟旦给药已被建议用于改善晚期心力衰竭（AdHF）患者的生存率。生活质量是 AdHF 患者的关键问题，频繁住院会对其产生负面影响。
对 CENTRAL、Google Scholar、MEDLINE/PubMed、Scopus 和 Cochrane 临床试验中央注册库（更新于 2017 年 1 月 15 日）进行了检索，以寻找调查间歇性左西孟旦给药对 AdHF 患者影响的随机对照试验。主要结局是治疗结束后 3 个月内需要再次住院的患者人数。共有 6 项试验的 319 名患者纳入了汇总分析。总体汇总分析显示，使用左西孟旦与 3 个月时再住院人数的显著减少相关：33/207（16%）与 39/113（35%），风险比 0.40，95%置信区间 0.27-0.59，P<0.001，I²=0%。敏感性分析也证实了这一结果。
在本荟萃分析的限制范围内，包括终点未独立判定且未明确规定的研究，对于 AdHF 患者重复或间歇性给予左西孟旦与 3 个月时的再住院率降低相关。需要进行大型、高质量的随机对照试验来证实这一发现。
