Home Dobutamine Infusion Combined with Opioid Therapy in Patients with Advanced Heart Failure

Home-based palliative care for patients with advanced heart failure remains challenging because refractory dyspnea and hemodynamic instability often require continuous medical support. Continuous dobutamine infusion is occasionally used to facilitate discharge to home in patients with end-stage heart failure; however, symptom relief with inotropic therapy alone may become insufficient during the terminal stage of illness. Reports describing the combined use of home dobutamine infusion and opioid therapy remain limited, particularly in Japan. We report two elderly patients with advanced heart failure who wished to spend their remaining time at home and were managed with continuous home dobutamine infusion combined with opioid therapy for symptom palliation. Case 1 involved an 84-year-old man with cardiac amyloidosis, severe mitral regurgitation (MR), and low cardiac output syndrome. Despite guideline-directed medical therapy and transcatheter edge-to-edge mitral valve repair, progressive fatigue and heart failure symptoms persisted. Continuous home dobutamine infusion was initiated, and transdermal fentanyl was subsequently added because of worsening dyspnea and discomfort. The patient remained at home and died 99 days after discharge. Case 2 involved a 91-year-old woman with advanced valvular heart disease, severe tricuspid regurgitation, pulmonary hypertension, and recurrent heart failure hospitalization. After temporary stabilization with dobutamine and symptom-oriented treatment, she was discharged home with continuous dobutamine infusion and opioid therapy. Although she died 5 days after discharge, her wish to remain at home was fulfilled. These cases suggest that combined home-based dobutamine infusion and opioid therapy may represent a feasible symptom-oriented palliative care strategy for selected patients with advanced heart failure who strongly prefer home-based end-of-life care. Further studies are needed to clarify patient selection, symptom outcomes, and safety considerations.