Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy
Gholami, Sherry
MGUH Internal Medicine Residency
MD
Resident PGY 1
Groninger, Hunter
MWHC
Najjar, Samer S
MHVI
Rao, Anirudh
MWHC
Sheikh, Farooq H
MHVI
Singh, Manavotam
MWHC Cardiovascular Disease Fellowship
MBBS
Fellow PGY 4
text
xx
2022
monographic
en
Background: Many patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients "crossover" from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.
Conclusion: Patients on CIIS as bridge therapy who do not ultimately receive surgical therapy "crossover" to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these "bridge to nowhere" patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy. Copyright © 2022 Rao, Singh, Maini, Anderson, Crowell, Henderson, Gholami, Sheikh, Najjar and Groninger.
Methods: Single-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.
Results: Of 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for "crossover" from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001).
English
IN PROCESS -- NOT YET INDEXED
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Cardiovascular Disease Fellowship
Internal Medicine Residency
Medicine/Palliative Care
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
2297-055X
https://dx.doi.org/10.3389/fcvm.2022.918146
https://dx.doi.org/10.3389/fcvm.2022.918146
Ovid MEDLINE(R)
221018