Abstract 18746: Variation in Intravenous Inotrope Use for Patients Hospitalized with Heart Failure: Data from Get withthe Guidelines
Background: Data guiding the use of intravenous inotrope agents for patients hospitalized with heart failure (HF) are sparse. Guidelines crudely recommend inotrope use for highly selected patients with decompensated HF, hypotension, and evidence of end-organ hypoperfusion. Real-world patterns of inotrope use are not well characterized.
Methods: We examined inotrope use for patients hospitalized with HF from 2005-2011 and enrolled in the Get With The Guidelines (GWTG-HF) registry. We used hierarchical logistic regression models to estimate risk-standardized hospital-level utilization rates of dobutamine, dopamine and milrinone, adjusting for clinical and demographic factors.
Results: Overall, 7,909 of 130,224 (6.1%) of HF patients hospitalized at 240 GWTG participating centers received inotrope administration (dobutamine 44%, dopamine 24%, milrinone 17%, combination 15%). Rates of inotrope use were constant from 2005 to 2011. At the hospital level, risk-standardized institutional rates of inotrope rates use ranged from 0-34% (median 5.1%, 25th-75th percentile 2.0-9.9%, Figure). Hospital region, rural location, size, and academic status were not significantly associated with the use of an inotropic agent.
Conclusion: Inotrope use during hospitalization varied markedly across participating hospitals. This degree of institutional variation, even after accounting for measured differences in case mix, suggests use patterns that are based to a greater degree on individual site propensity than by patient factors. The implications of these markedly different patterns of care are worthy of further investigation .
- © 2012 by American Heart Association, Inc.