[Infusion therapy at outpatient clinic in chronic end-stage heart failure]
Kiyoto Nishi1, Yukihito Sato, Tadashi Miyamoto
1Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Higashidaimotsucho 1-1-1, Amagasaki, Hyogo.
Insights
Ambulatory infusions of carperitide, olprinone, or catecholamines were safe for end-stage congestive heart failure patients. This therapy reduced hospitalization duration, offering an end-of-life treatment option.
Area of Science:
- Cardiology
- Pharmacology
Context:
- End-stage congestive heart failure (CHF) poses significant challenges for patient management and quality of life.
- Hospitalization is a common and burdensome outcome for patients with advanced CHF.
Purpose:
- To evaluate the safety and efficacy of ambulatory, low-dose drug infusions in end-stage CHF patients.
- To determine if these infusions reduce the length of hospital stays.
Summary:
- A study involving 21 ambulatory end-stage CHF patients assessed infusions of carperitide, olprinone, or catecholamines (dopamine/dobutamine).
- No adverse events were observed, and carperitide infusions lowered blood pressure, while catecholamines increased it. Olprinone had no significant effect.
- Urinary output correlated with pre-infusion blood pressure. Infusion therapy was associated with a reduced hospitalization period in some patients.
Impact:
- Ambulatory infusion therapy for end-stage CHF is safe and may be an acceptable end-of-life therapeutic strategy.
- While not directly reducing mortality, this approach can improve patient management by shortening hospital stays.
Objectives:
To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization.
Methods:
Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr).
Results:
Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005.
Conclusions:
Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option.
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