Long-term (&gt;8 weeks) home inotropic therapy as destination therapy in patients with advanced heart failure or as bridge to heart transplantation

Jiménez, Javier; Jara, Jessica; Bednár, B; Bauerlein, Joseph; Mallon, Stephen

doi:10.1016/j.ijcard.2003.11.064

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…[15][16][17] The use of AI in adults has also been studied. [1][2][3][4][18][19][20] Although these studies are smaller, they did show that AI are feasible in the adult population. There is a reduced cost associated with AI compared with continued inpatient inotropic treatment.…”

Section: Discussionmentioning

confidence: 90%

“…1 Several studies in the adult population have shown this therapy to potentially be harmful to patients with worse outcomes while on inotropic therapy compared with no intravenous inotrope use. [2][3][4] The pediatric HF population uses this therapy as a bridge to transplantation, in part because of the limited availability of ventricular assist devices (VADs) in children. 5 Although many patients on inotropic therapy are clinically unstable, a subset of this population may safely await transplantation at home.…”

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confidence: 99%

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Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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Background-Intravenous inotropic therapy can be used to support children awaiting heart transplantation. Although use of this therapy is discouraged in adults because of poor outcomes, its use in children, particularly outpatient, has had limited evaluation. We aimed to evaluate the safety and efficacy of this practice. Methods and Results-A retrospective analysis of an intent to treat protocol was completed on United Network for Organ Sharing status 1A patients discharged on inotropic therapy from 1999 until 2012. Intravenous inotropic therapy was initiated for cardiac symptoms not amenable to oral therapy. Patients who were not status 1A or required >1 inotrope were excluded. Efficacy was analyzed by time to first event: transplantation; readmission until transplantation; improvement leading to inotrope withdrawal; or death. Safety included analysis of infection rates, line malfunctions, temporary hospitalization, neurological events, and arrhythmias. One hundred six patients met inclusion criteria. The mean age was 10.1±6.4 years, 47% of patients had congenital heart disease, and 80% of these patients had single ventricle physiology.In patients without congenital heart disease, 53% had dilated cardiomyopathy, 91% of patients received milrinone, 85% of patients underwent transplantation, 8% of patients successfully weaned from support as outpatients, whereas 6% died. Fifty percent of patients were readmitted before transplantation or weaning from support, of which 64% required only 1 readmission. The majority of readmissions were for heart failure. Conclusions-Outpatient intravenous inotropic therapy can be safely used as a bridge to transplantation in pediatric patients.A minority of patients can discontinue inotropic therapy because of clinical improvement. (Circ Heart Fail. 2015;8:64-70.

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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“…Positive inotropic therapy has been shown to improve symptoms and functional ability [14][15][16], and continuous outpatient support with inotropes (COSI) has been used as support for patients awaiting transplantation and as well as palliative therapy for patients dying of refractory heart failure [14][15][16][17][18][19]. In our program, the use of COSI as palliative therapy in inotrope-dependent patients resulted in a median survival of 3.2 months [5] (Fig.…”

Section: Introductionmentioning

confidence: 90%

The use of positive inotropes in end-of-life heart failure care

Nauman

2007

Curr Heart Fail Rep

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End-stage heart failure is associated with mortality equivalent to cancer, yet there is little information about palliative therapy for this disease. Chronic outpatient support with inotropes provides symptomatic relief and life extension for those select patients demonstrating dependence on positive inotropic therapy. The purpose of this review is to provide information about process and implementation of chronic outpatient support with inotropes in patients with end-stage heart failure.

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“…Their focus was mainly on clinical feasibility, 12-15 safety, 15 cost-effectiveness and resource utilization, 12,16,17 and as a bridge to transplantation or for palliation. 12,14,15,18 We present new information on a common clinical dilemma: the prognostic implications of choosing between dobutamine and milrinone for patients with stage D HF being discharged from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Prognosis on Chronic Dobutamine or Milrinone Infusions for Stage D Heart Failure

Gorodeski

Chu

Reese

et al. 2009

Circ: Heart Failure

133

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Long-term (>8 weeks) home inotropic therapy as destination therapy in patients with advanced heart failure or as bridge to heart transplantation

Cited by 9 publications

References 15 publications

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

The use of positive inotropes in end-of-life heart failure care

Prognosis on Chronic Dobutamine or Milrinone Infusions for Stage D Heart Failure

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