Continuous Intravenous Inotropic Support for Advanced Heart Failure: Palliative Considerations

McPherson, Alexandra; Nguyen, Cindy; Groninger, Hunter; Anderson, Kelley M.; Henderson, Paul R.; Rao, Anirudh

doi:10.1080/15360288.2022.2050456

Cited by 4 publications

(4 citation statements)

References 47 publications

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“…The superiority of intravenous PPIs in managing rebleeding aligns with previous studies, such as those by Anderson [27], which also noted improved outcomes with high-dose intravenous administration. However, our findings provide additional evidence supporting its use in routine clinical practice after endoscopic therapy for bleeding peptic ulcers.…”

Section: Comparison With Existing Literaturesupporting

confidence: 86%

Comparing High-Dose PPI Intravenous Infusion and Oral Acid Pump Inhibitors After Endoscopic Therapy for Bleeding Peptic Ulcers

Miao,

Dai,

et al. 2024

Preprint

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This mini-review explores the comparative efficacy, safety, and clinical outcomes of high-dose proton pump inhibitor (PPI) intravenous infusion versus oral acid pump inhibitor therapy following endoscopic treatment for bleeding peptic ulcers. Recent evidence suggests that intravenous PPIs can significantly reduce the rebleeding rates within the critical first 72 hours post-intervention, with a noted rebleeding rate of 6% compared to 14% in patients receiving oral Vonoprazan (VPZ) therapy. Additionally, the rapid onset of action associated with intravenous administration leads to faster stabilization of vital signs and a reduced need for subsequent blood transfusions. Safety profiles for both intravenous and oral VPZ were favourable, with minimal adverse effects, the most common being transient headaches.However, the findings from our single-centre study with a moderate sample size prompt consideration of more extensive, multicentre trials to enhance the generalizability of the results. Current limitations include potential biases, short-term focus, missing data issues, and a need for long-term outcome data, necessitating further research. Future studies should also explore the cost-effectiveness of intravenous versus oral VPZ and the impact on patient quality of life and long-term mortality rates.This review underscores the importance of tailored PPI therapy in managing bleeding peptic ulcers post-endoscopy. It suggests a potentially pivotal role for intravenous PPIs in high-risk patient groups, advocating for a shift towards more aggressive and immediate care protocols in specific clinical settings.

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Section: Comparison With Existing Literaturesupporting

confidence: 86%

Comparing High-Dose PPI Intravenous Infusion and Oral Acid Pump Inhibitors After Endoscopic Therapy for Bleeding Peptic Ulcers

Miao,

Dai,

et al. 2024

Preprint

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“…19 Given the lower cost of dobutamine compared to milrinone, it is possible that certain regions have more hospice agencies that provide CIIS. 15 The contemporary practice of most hospices in the Washington DC metropolitan area is to accept patients once they are weaned off CIIS or with clear intention to wean off CIIS within days-weeks of hospice admission. The patients in our cohort who were referred to hospice (n = 45; 60%) were likely referred towards the end of their treatment course with CIIS.…”

Section: Discussionmentioning

confidence: 99%

“…Initially indicated in patients with chronic HF refractory to standard therapy, the role of CIIS now includes palliative symptomatic relief to improve functional class and quality of life. 15 The increasing use of CIIS as palliative therapy in patients with end-stage HF underscores the need for detailed study of the harms and benefits of CIIS to guide shared decision making with patients and families. To our knowledge, this is the first report of a cohort of patients receiving CIIS for an exclusive palliative indication detailing both the benefits and harms associated with CIIS.…”

Section: Discussionmentioning

confidence: 99%

Benefits and Harms of Continuous Intravenous Inotropic Support as Palliative Therapy: A Single-Institution, Retrospective Analysis

Rao

Maini

Anderson

et al. 2023

Am J Hosp Palliat Care

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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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“…Besides, digoxin can increase the oxygen consumption of cardiomyocytes and lead to digitalis poisoning [ 41 ]. In comparison, milrinone can repair cardiomyocyte injury through both positive myodynamia and vasodilation [ 42 – 44 ]. With the continuation of milrinone treatment, the effects of milrinone on cardiac output and myocardial contractility can effectively improve their cardiac function [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Milrinone for the treatment of heart failure caused by severe Pneumonia in children with congenital heart disease: a meta-analysis

Shao,

Diao,

Zhou

et al. 2023

BMC Pediatr

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Background Children with congenital heart disease (CHD) are easily complicated by severe pneumonia and heart failure. We aimed to conduct a meta-analysis to evaluate the effects and safety of milrinone for the treatment of heart failure caused by severe pneumonia in children with CHD to provide evidence for the clinical CHD treatment. Methods Two authors searched MEDLINE, PubMed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, the Cochrane Library, Wanfang database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) about the application of milrinone in the treatment of heart failure caused by severe pneumonia in children with CHD in children up to December 10, 2022. Two evaluators independently selected the literature, extracted data and evaluated the methodological quality, meta-analysis was carried out with RevMan 5.3 software. Results Eight RCTs involving 680 CHD children complicated by severe pneumonia and heart failure were included in this meta-analysis. Meta-analysis indicated that total effective rate of the milrinone group was higher than that of control group (RR = 1.25, 95%CI: 1.17 ~ 1.34, P < 0.001), the time to stable heart rate of the milrinone group was less than that of control group (RR=-0.88, 95%CI: -1.09~ -0.67, P < 0.001). The time to stable respiration of the milrinone group was less than that of control group (RR=-0.98, 95%CI: -1.17~ -0.78, P < 0.001). The LVEF of the milrinone group was higher than that of control group (RR = 6.46, 95%CI: 5.30 ~ 7.62, P < 0.001). There was no significant difference in the incidence of adverse reactions between the milrinone group and control group (RR = 0.85, 95%CI: 0.47 ~ 1.56, P = 0.061). Funnel plots and Egger regression test results indicated that there were no statistical publication bias amongst the synthesized outcomes (all P > 0.05). Conclusions Milrinone is beneficial to improve clinical symptoms and cardiac function and increase the therapeutic effect and safety in children with CHD complicated by severe pneumonia and heart failure. However, more RCTs with large samples and rigorous design are needed to verify this finding.

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Continuous Intravenous Inotropic Support for Advanced Heart Failure: Palliative Considerations

Cited by 4 publications

References 47 publications

Comparing High-Dose PPI Intravenous Infusion and Oral Acid Pump Inhibitors After Endoscopic Therapy for Bleeding Peptic Ulcers

Comparing High-Dose PPI Intravenous Infusion and Oral Acid Pump Inhibitors After Endoscopic Therapy for Bleeding Peptic Ulcers

Benefits and Harms of Continuous Intravenous Inotropic Support as Palliative Therapy: A Single-Institution, Retrospective Analysis

Milrinone for the treatment of heart failure caused by severe Pneumonia in children with congenital heart disease: a meta-analysis

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