Chronic inotropic therapy in end-stage heart failure

Area of Science:

• Cardiology
• Pharmacology
• Health Economics

Background:

• Advanced heart failure interventions aim to improve symptoms and reduce hospital readmissions.
• Chronic intravenous inotropic therapy is a palliative approach, but its impact on mortality and cost is not well understood.
• Understanding the resource utilization and survival outcomes of chronic infusions is crucial.

Purpose of the Study:

• To evaluate the impact of chronic intravenous inotropic therapy on healthcare resource use and survival in patients with advanced heart failure.
• To analyze mortality rates and healthcare expenditures associated with long-term inotropic infusions.

Main Methods:

• Retrospective review of Medicare data from 1995-2002 across 17 states.
• Analysis of hospital and outpatient expenditures up to 180 days before and after initiating chronic infusions.
• Calculation of healthcare use based on drug reimbursement and hospitalizations per beneficiary, with cost curves generated over time.

Main Results:

• The study cohort (n=331) had a mean age of 69.1 years, with over 40% mortality within 6 months.
• Reductions in hospital days were observed post-infusion initiation.
• While drug costs (milrinone) were significant at 6 months, initial expenditures favored drug therapy over hospitalizations at 30 and 60 days.

Conclusions:

• Chronic intravenous inotropic therapy is associated with substantial mortality in advanced heart failure.
• The cost of milrinone is significant, yet it may lead to decreased subsequent hospitalization expenditures.
• Clinical decisions regarding the initiation, choice, and duration of inotropic therapy should consider both patient outcomes and resource utilization.