Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart Failure: A Single-Center Experience
Section snippets
Methods
With institutional review board approval from the MedStar Health Research Institute, we conducted a retrospective cohort study of adult patients with advanced HF who were discharged on inotropes from MedStar Washington Hospital Center, an urban, tertiary-care, academic hospital, between 2010 and 2016. Patients were identified at discharge according to the index hospitalization during which CIIS was initiated, and follow-up and additional data were gathered by the study’s investigators.
Baseline Characteristics
Between January 2010 and December 2016, 373 consecutive patients were discharged on CIIS (Table 1). All patients had ACC/AHA Stage D HF, with median ejection fraction of 20% (IQR 17.5%--22.5%). Two-thirds of the patients in the study received CIIS as bridge therapy (n = 246; 66%), and the remainder received CIIS as palliative therapy (n = 127; 34%). The median age at CIIS initiation was 60.7 years (IQR 50.7--69.6 years). Patients on CIIS as palliative therapy were significantly older than those
Discussion
We describe the clinical trajectory of patients initiated on CIIS, comparing patients on CIIS as palliative therapy vs bridge therapy. In this large retrospective cohort study of a racially diverse population, we observed that patients on CIIS as palliative therapy survived an average of approximately 6 months but with marked variability among individual patients, as reflected by the large standard deviation. We note that CIIS was effective in bridging most patients with advanced HF to surgical
Conclusions
This large, retrospective cohort study demonstrates that patients with advanced HF receiving CIIS as bridge therapy or as palliative therapy are maintained on the inotrope for close to 6 months on average. The majority of patients on CIIS as bridge therapy receive an LVAD or HT in 4.5 months, on average, whereas the majority of patients on CIIS as palliative therapy die or are referred to hospice in 6.2 months, on average, though with significant heterogeneity among patients. Patients on CIIS
Sources of Funding
The authors report no sources of funding.
Disclosures
The authors have no conflicts of interests to disclose.
Acknowledgments
The authors thank Reiko Asano for contributions to this manuscript.
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