Quality of life and long‐term mortality in patients with advanced chronic heart failure treated with intermittent low‐dose intravenous inotropes in an outpatient setting

Abstract

AimsThere are limited data on the effect of low‐dose, intermittent inotropic therapy in an outpatient setting on the quality of life (QOL) in patients with advanced refractory heart failure (HF) symptoms. We aimed to analyse the effect of this treatment modality on QOL and subsequent survival.Methods and resultsThe study population comprised 287 consecutive patients with advanced refractory HF symptoms who were treated with low‐dose, intravenous intermittent inotropic therapy in the HF Day Care Service at Sheba Medical Centre between September 2000 and September 2012. All patients completed a baseline Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and 137 (48%) completed a 1 year follow‐up questionnaire. MLWHFQ scores' means ranged from 0 (better QOL) to 5 (worse QOL). Mean age was 68 ± 12, 86% were men, 77% had ischaemic cardiomyopathy, and the mean left ventricle ejection fraction (LVEF) was 26% ± 13. The mean baseline MLWHFQ score was 3.1 (±1), while the mean at 1 year of treatment was of 2.7 (±1.1), indicating an overall improvement in QOL associated with intermittent low‐dose inotrope therapy (p < 0.01). Multivariate analysis showed that younger age, non‐ischaemic cardiomyopathy, and worse renal function were independently associated with improvement in QOL at 1 year. Improvement in QOL was not associated with a significant survival benefit during subsequent follow‐up.ConclusionsIn patients with advanced refractory HF symptoms, treatment with low‐dose, intermittent intravenous inotropes in an outpatient setting is associated with significant improvement in QOL. However, improvement in QOL in this population does not appear to affect subsequent long‐term survival.

Effects of intravenous home dobutamine in palliative end‐stage heart failure on quality of life, heart failure hospitalization, and cost expenditure

“…Several small‐sized and medium‐sized cohort studies have looked at the impact of intravenous home inotropic support . However, the indication for the use of inotropic support was often very diverse including end‐stage heart failure awaiting transplantation or left ventricular assist device placement .…”

“…However, the indication for the use of inotropic support was often very diverse including end‐stage heart failure awaiting transplantation or left ventricular assist device placement . Furthermore, the mode of inotropic delivery varied between intermittent home administration, continuous home administration, and intermittent inpatient administration . Additionally, the intravenous drug reported varied between milrinone, dobutamine, and dopamine .…”

“…2,5 Several small-sized and medium-sized cohort studies have looked at the impact of intravenous home inotropic support. [6][7][8][9] However, the indication for the use of inotropic support was often very diverse including end-stage heart failure awaiting transplantation or left ventricular assist device placement. 9 Furthermore, the mode of inotropic delivery varied between intermittent home administration, continuous home administration, and intermittent inpatient administration.…”

“…9 Furthermore, the mode of inotropic delivery varied between intermittent home administration, continuous home administration, and intermittent inpatient administration. [6][7][8] Additionally, the intravenous drug reported varied between milrinone, dobutamine, and dopamine. 8 In contrast, we report on a very homogenous population undergoing a simplified treatment regimen.…”

A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus

“…Patients with AdvHF suffer from severe and persistent symptoms, often unresponsive to drug therapy, poor performance status with marked limitation in exercise capacity, significantly impaired quality of life (QoL), progressive deterioration of multiple organ function such as renal and hepatic functions, intolerance to disease-modifying therapies and repeated hospitalizations [30]. A proposed classification of AdvHF that identifies the involvement of other organs besides the heart allows to distinguish AdvHF from end-stage cardiac patients [44].…”