Levosimendan in heart failure with reduced ejection fraction — effects on prognosis, hospitalizations, and the role of combination therapy

Background

Heart failure with reduced ejection fraction (HFrEF) remains a leading cause of hospitalization and cardiovascular mortality worldwide. Despite major advances in guideline-directed medical therapy, episodes of decompensation frequently require inotropic support. Levosimendan, a calcium-sensitizing inodilator, has emerged as an alternative to conventional catecholaminergic inotropes. Levosimendan may be considered in selected patients with acute or advanced HFrEF, particularly for temporary or intermittent inotropic support. Further studies are needed to determine its impact on long-term survival. This review summarizes current evidence regarding the use of levosimendan in HFrEF with particular focus on survival, duration of hospitalization, rehospitalization rates, and outcomes of combination therapy with modern heart failure drugs.