Effect of levosimendan treatment on length of hospital and intensive care stay in the REVIVE I study

Background

Hospitalisation, especially length of stay in intensive care, is the main cost driver in heart failure (HF). Levosimendan, a novel calcium sensitiser, improves both short-term and long-term outcome of patients with acute HF.

Objective

To evaluate the length of intensive care and hospital stay in acute decompensated HF patients treated with levosimendan compared with placebo.

Methods

The REVIVE I trial was a pilot trial comprising 100 patients with acute HF who were hospitalised for worsening HF and had dyspnea at rest despite intravenous (IV) diuretics. Patients were randomised (double-blind) to receive placebo (PBO) (n = 49) or IV levosimendan (LS) (n = 51), given as a loading dose of 12 μg/kg over 10 min and followed by a continuous infusion (0.1 μg/kg/hour for 50 min and 0.2 μg/kg/hour for 23 hours). Among other measures, the duration of hospitalisations and intensive care (ICU/CCU) were prospectively recorded.

Results

At baseline, 34 out of 51 (67%) patients in the LS group, and 25 out of 49 (51%) patients in the PBO group were treated in the ICU/CCU. One levosimendan and three placebo-treated patients were subsequently admitted to the ICU/CCU after randomisation. The mean treatment time at the ICU/CCU was 4.4 days in the LS group and 5.1 days in the PBO group (median 4 days vs 5 days). The mean duration of index hospitalization after randomization was 5.7 days for the LS group and 6.8 days for the PBO group (median 5 days in both groups). After the initial discharge, one patient in the LS group and seven patients in the PBO group were admitted to the ICU/CCU during a subsequent rehospitalization up to day 31. The mean treatment time at the ICU/CCU for these patients was 2.0 days in the LS group and 4.4 in the PBO group (median 2 days vs 5 days).

Conclusions

Of the acute HF patients who were admitted to intensive care, those treated with levosimendan spent on average 1 day less in an ICU/CCU than patients treated with usual care. Shortening the ICU treatment time by 1 day without increasing the total length of the initial hospitalisation could reduce total hospitalisation costs by up to US$2000–3000 per patient. These promising initial results await confirmation in the ongoing REVIVE II trial.