Continuous cardiac inotropes in patients with end-stage heart failure: an evolving experience.

MedStar author(s):
Citation: Journal of Pain & Symptom Management. 55(1):159-163, 2018 Jan.PMID: 29030210Institution: MedStar Union Memorial Hospital | MedStar Washington Hospital CenterDepartment: Medicine/Palliative CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiotonic Agents/ad [Administration & Dosage] | *Heart Failure/th [Therapy] | *Hospice Care | *Milrinone/ad [Administration & Dosage] | Cardiotonic Agents/ec [Economics] | Heart Failure/ec [Economics] | Hospice Care/ec [Economics] | Hospice Care/mt [Methods] | Humans | Infusions, Intravenous | Male | Middle Aged | Milrinone/ec [Economics] | Palliative Care/ec [Economics] | Palliative Care/mt [Methods]Year: 2017Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0885-3924
Name of journal: Journal of pain and symptom managementAbstract: Copyright (c) 2017. Published by Elsevier Inc.Heart failure experts recommend initiation of continuous inotrope therapy, such as milrinone or dobutamine, for clinically decompensating patients with stage D heart failure. Although originally intended to serve solely as a bridge to more definitive surgical therapies, more and more patients are receiving inotrope therapy for purely palliative purposes. In these cases, questions arise regarding care at the end of life. What criteria determine ongoing clinical benefit? Should the inotrope be continued until death? Should inotrope dosing be increased within recommended guidelines to improve symptoms? What is the role of inotropes in hospice care? Here, we describe such a case as a springboard to contemplate the evolving role of inotrope therapies and how hospice and palliative providers may interface with this rapidly developing face of advanced heart failure care.All authors: Groninger H, Malotte K, Saguros AFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-11-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29030210 Available 29030210

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

Copyright (c) 2017. Published by Elsevier Inc.

Heart failure experts recommend initiation of continuous inotrope therapy, such as milrinone or dobutamine, for clinically decompensating patients with stage D heart failure. Although originally intended to serve solely as a bridge to more definitive surgical therapies, more and more patients are receiving inotrope therapy for purely palliative purposes. In these cases, questions arise regarding care at the end of life. What criteria determine ongoing clinical benefit? Should the inotrope be continued until death? Should inotrope dosing be increased within recommended guidelines to improve symptoms? What is the role of inotropes in hospice care? Here, we describe such a case as a springboard to contemplate the evolving role of inotrope therapies and how hospice and palliative providers may interface with this rapidly developing face of advanced heart failure care.

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