Benefits and Harms of Continuous Intravenous Inotropic Support as Palliative Therapy: A Single-Institution,
Anirudh Rao1,2, Mansi Maini1, Kelley M Anderson3
1Georgetown University School of Medicine, Washington, DC, USA.
Insights
Continuous intravenous inotropic support (CIIS) as palliative therapy for end-stage heart failure (HF) improves functional class but leads to frequent hospitalizations and infections. Further research is needed to balance benefits and harms.
Area of Science:
- Cardiology
- Palliative Care
- Medical Ethics
Background:
- Continuous intravenous inotropic support (CIIS) is increasingly used for palliative end-stage heart failure (HF).
- The potential harms of CIIS may outweigh its benefits in this population.
- Understanding the balance of benefits and harms is crucial for informed clinical decision-making.
Purpose of the Study:
- To describe the benefits, such as improved NYHA functional class, and harms, including infection and hospitalization rates, of CIIS used as palliative therapy.
- To analyze clinical outcomes for patients with end-stage HF receiving CIIS for palliative care.
Main Methods:
- Retrospective analysis of 75 patients with end-stage HF initiated on CIIS for palliative therapy between 2014-2016.
- Data on functional class, hospitalizations, intensive care unit (ICU) admissions, infections, and days spent in hospital were extracted and analyzed using descriptive statistics.
Main Results:
- Most patients (69.3%) improved from NYHA class IV to III.
- A high rate of hospitalization (89.3%) was observed, with an average of 2.7 admissions per patient.
- Significant occurrences of ICU admissions (33.3%) and catheter-related bloodstream infections (14.7%) were noted, with patients spending approximately 40 days hospitalized during CIIS therapy.
Conclusions:
- CIIS as palliative therapy for end-stage HF can improve functional class and patients survive for a median of 6.5 months.
- However, patients experience substantial hospitalization burdens and infectious complications.
- Prospective studies are warranted to precisely quantify symptomatic benefits and the direct/indirect harms of CIIS in palliative HF care.
Abstract:
Use of continuous intravenous inotropic support (CIIS) strictly as palliative therapy for patients with ACC/AHA Stage D (end-stage) Heart Failure (HF) has increased significantly. The harms of CIIS therapy may detract from its benefits. To describe benefits (improvement in NYHA functional class) and harms (infection, hospitalization, days-spent-in-hospital) of CIIS as palliative therapy. Methods: Retrospective analysis of patients with end-stage HF initiated on CIIS as palliative therapy at an urban, academic center in the United States between 2014-2016. Clinical outcomes were extracted, and data were analyzed using descriptive statistics. Seventy-five patients, 72% male, 69% African American/Black, with a mean age 64.5 years (SD = 14.5) met study criteria. Mean duration of CIIS was 6.5 months (SD = 7.7). Most patients (69.3%) experienced improvement in NYHA functional class from class IV to class III. Sixty-seven patients (89.3%) were hospitalized during their time on CIIS, with a mean of 2.7 hospitalizations per patient (SD = 3.3). One-third of patients (n = 25) required at least one intensive care unit (ICU) admission while on CIIS therapy. Eleven patients (14.7%) experienced catheter-related blood stream infection. Patients spent an average of 20.6% (SD = 22.8), approximately 40 days, of their time on CIIS admitted to the study institution. Patients on CIIS as palliative therapy report improvement in functional class, survive 6.5 months following initiation, but spend a significant number of days in the hospital. Prospective studies quantifying the symptomatic benefit and the direct and indirect harms of CIIS as palliative therapy are warranted.
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