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Continuous Intravenous Inotropic Support for Advanced Heart Failure: Palliative Considerations
Journal of Pain & Palliative Care Pharmacotherapy
|March 23, 2022
Summary
Chronic intravenous inotropic support (CIIS) offers symptom relief for advanced heart failure (HF) patients. While evidence is limited, CIIS may improve quality of life and functional status, but requires careful consideration of risks.
Area of Science:
- Cardiology
- Palliative Care
- Pharmacology
Background:
- Increasing global prevalence of heart failure (HF) leads to more patients with advanced disease.
- Improved survival with guideline-directed medical and device therapy results in a growing population needing advanced care.
- Limited options for advanced surgical interventions (mechanical circulatory support, heart transplantation) for many advanced HF patients.
Purpose of the Study:
- To review the role of chronic intravenous inotropic support (CIIS) in managing advanced heart failure (HF).
- To examine the pharmacology, benefits, burdens, and guideline recommendations for CIIS.
- To discuss considerations for hospice and end-of-life care in patients receiving CIIS.
Main Methods:
- Literature review of existing clinical evidence on CIIS in advanced HF.
- Analysis of data regarding functional class, quality of life, symptom burden, and hemodynamic parameters.
- Consideration of risks, burdens, and monitoring requirements associated with CIIS.
Main Results:
- Available data suggest CIIS may improve functional class, health-related quality of life (HRQoL), and reduce symptom burden.
- Potential benefits include improved hemodynamic parameters and possibly reduced rehospitalization rates.
- CIIS is associated with risks including infection, adverse drug effects, need for monitoring, and caregiver support.
Conclusions:
- CIIS is increasingly used for palliation of symptoms in advanced HF patients not suitable for or declining surgical interventions.
- While evidence is limited, CIIS shows potential benefits for symptom management and quality of life.
- Careful consideration of risks, burdens, and patient goals is essential before initiating CIIS.
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