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.

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

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.

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).

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.