Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart Failure: A Single-Center Experience

被引:11
|
作者
Rao, Anirudh [1 ,2 ]
Anderson, Kelley M. [3 ]
Mohammed, Selma [4 ]
Hofmeyer, Mark [5 ]
Gholami, Sherry S. [1 ]
Sheikh, Farooq H. [5 ]
Rodrigo, Maria E. [5 ]
Crowell, Nancy A. [3 ]
Javed, Hasan [5 ]
Gupta, Shantal [5 ]
Hajouli, Said [6 ]
Stewart, Diana E. [7 ]
Hamad, Ahmad [8 ]
Najjar, Samer S. [5 ]
Groninger, Hunter [1 ,2 ]
机构
[1] Georgetown Univ, Sch Med, Dept Med, Washington, DC USA
[2] MedStar Washington Hosp Ctr, Dept Med, Sect Palliat Care, Washington, DC USA
[3] Georgetown Univ, Sch Nursing & Hlth Studies, Washington, DC USA
[4] Creighton Univ, Sch Med, Dept Med, Omaha, NE 68178 USA
[5] MedStar Washington Hosp Ctr, MedStar Heart & Vasc Inst, Adv Heart Failure Program, Washington, DC USA
[6] Logan Reg Med Ctr, Dept Med, Logan, WV USA
[7] Buffalo Gen Med Ctr, Dept Med, Buffalo, NY USA
[8] Ohio State Univ, Dept Surg, Wexner Med Ctr, Columbus, OH 43210 USA
关键词
Heart failure; left ventricular assist device; palliative care; inotropes; VENTRICULAR ASSIST DEVICE;
D O I
10.1016/j.cardfail.2021.06.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. Methods: We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. Results: Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SDI 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. Conclusions: In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.
引用
收藏
页码:974 / 980
页数:7
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