Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart Failure: A Single-Center Experience.
Citation: Journal of Cardiac Failure. 27(9):974-980, 2021 09.PMID: 34153459Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Medicine/Palliative CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiovascular Agents | *Heart Failure | Cardiotonic Agents/tu [Therapeutic Use] | Heart Failure/dt [Drug Therapy] | Humans | Palliative Care | Retrospective StudiesYear: 2021Local holdings: Available online from MWHC library: 1995 - presentISSN:- 1071-9164
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 34153459 | Available | 34153459 |
Available online from MWHC library: 1995 - present
BACKGROUND: Many patients with ACC/AHA Stage D (advanced) HF 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 (HF) on home CIIS.
CONCLUSIONS: In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived 6.2 months, on average, with wide variation between patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality in this sub-group. Copyright (c) 2021. Published by Elsevier Inc.
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 of palliative care.
RESULTS: Overall, patients received CIIS therapy for an average of 5.9 months (SD 7.3). Patients on CIIS as palliative therapy died 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.
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