Abstract 11166: Pediatric Heart Failure Patients Can be Safely Discharged on Home Inotropic Medications With a Substantial Minority Able to Discontinue Inotropic Medications
Background: Ambulatory intravenous inotropes (II) are discouraged in adult heart failure (HF) due to high rates of mortality. Isolated experience suggests ambulatory II are used in pediatric HF with uncertain outcomes. We hypothesized ambulatory II therapy can be safely utilized in pediatric HF as a bridge to heart transplant (HT).
Methods: Competing risk analysis was performed in patients discharged home on II after failing weaning in hospital as Status 1A pediatric HT candidates to determine cumulative rates of death, HT, unplanned readmission (RA), and improvement leading to withdrawal of II. Multivariate analysis was performed to determine factors for death, RA, and withdrawal of II.
Results: 108 patients (mean age 10.1± 6.4 years, 50% male, 48% CHD) were initiated on ambulatory II (91% milrinone) from 1999-2012. First event (Figure) was RA (49%), HT (38%), II withdrawal (9%), and death (3%). The rates of HT and first RA plateaued approximately 2 months after initiation of ambulatory II while withdrawal of II tended to occur within one month. 66% of RA were for exacerbation of HF with 60% of these resulting in discharge. Cause of death on ambulatory II was sudden death (1), progression of plastic bronchitis (1), and influenza B (1) 19, 52, and 32 days after discharge respectively. Non-HF hospitalizations were primarily due to IV malfunction (14%), with 4% having a line infection. An association of age, HF etiology, previous surgery, and other demographic or clinical variables to risk of death, RA or withdrawal of II was not found.
Conclusion: Ambulatory II therapy in pediatric HT candidates is a safe and effective way to palliate HF. The substantial minority of patients who were ultimately able to be withdrawn from II after initial failure suggests a short period of observation on II after initial withdrawal failure may obviate a need for HT. Further studies with larger sample size are needed to elucidate factors associated with mortality, morbidity, and improvement.
- © 2013 by American Heart Association, Inc.