Use of intravenous inotropic therapy in the home

The role of home i.v. inotropic therapy in managing patients with refractory congestive heart failure (CHF) is reviewed. CHF is a fairly common health care problem in the United States and is associated with significant morbidity and mortality. Although several oral medications are used to treat CHF, individuals with New York Heart Association class III or IV disease may require i.v. inotropic therapy. Typically, these patients are managed in the hospital. However, some patients dependent on i.v. therapy may be safely treated at home. While the functional status and quality of life of these individuals may be improved, there is no evidence that home i.v. inotropic therapy increases their overall survival. Dobutamine is currently the preferred i.v. inotropic agent, but amrinone and milrinone are suitable alternatives. Although tolerance to dobutamine may develop with continuous drug administration, intermittent therapy has been associated with an increased risk of sudden death. The optimal infusion schedules for amrinone and milrinone have not been clearly established. Home i.v. inotropic therapy may improve the quality of life in carefully selected patients with refractory CHF.