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Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart

Anirudh Rao1, Kelley M Anderson2, Selma Mohammed3

  • 1Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.

Journal of Cardiac Failure
|June 21, 2021
PubMed

Insights

Patients with advanced heart failure on home intravenous inotropic support (CIIS) had varied survival. Those on CIIS for palliative care survived 6.2 months, while bridge therapy patients not receiving surgery had less palliative care.

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Palliative Care

Background:

  • Many patients with advanced heart failure (Stage D) receive home chronic intravenous inotropic support (CIIS).
  • CIIS is used as a bridge to surgery or for palliative therapy.
  • Understanding the clinical trajectory of these patients is crucial.

Purpose of the Study:

  • To analyze the clinical outcomes of patients with advanced heart failure on home CIIS.
  • To compare survival and palliative care utilization based on the indication for CIIS.

Main Methods:

  • Retrospective cohort study of 373 patients on CIIS from 2010-2016.
  • Stratification by indication: bridge to surgery vs. palliative therapy.
  • Outcomes included time to cessation of CIIS, time to death, and palliative care consultation rates.

Main Results:

  • Average CIIS duration was 5.9 months.
  • Patients on CIIS for palliative therapy survived an average of 6.2 months.
  • Patients on CIIS as bridge therapy who did not receive surgery survived an average of 8.6 months but received less palliative care.

Conclusions:

  • Patients on CIIS for palliative therapy show significant survival variability.
  • Patients on CIIS as bridge therapy who do not undergo surgery have high mortality and underutilize palliative care.
  • Improved palliative care integration is needed for advanced heart failure patients on CIIS bridge therapy.
Abstract

Keywords:
Heart failureinotropesleft ventricular assist devicepalliative care

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