Abstract 12776: Outcomes and Survival With Home Intravenous Inotrope Therapy in Contemporary Heart Failure Management
Introduction: Inotrope use in decompensated congestive heart failure (CHF) is associated with improved hemodynamics, but did not improve outcomes in previous trials, with 50% 6-month mortality. However, many of these studies predated modern CHF therapies, including aldosterone antagonists, implantable cardioverter-defibrillators (ICDs), and resynchronization. We evaluated contemporary survival and outcomes on long-term inotropes in advanced CHF.
Methods: We collected baseline and post-inotrope data on 197 consecutive patients discharged from our hospital between January 2007 and March 2013 on intravenous inotropes. Clinical, hemodynamic, catheterization, and survival data were collected. T-tests and Chi-square tests were used to compare outcomes, and Kaplan-Meier curves to evaluate survival.
Results: Among the 197 patients, 25.8% were women, 40% had ischemic etiology and mean age was 54.4 years (standard deviation [SD] 14.6 years). Patients started on inotropes had CHF refractory to standard management, with mean baseline NYHA 3.7, cardiac index (CI) 1.7 L/min/m2, pulmonary capillary wedge pressure (PCWP) 25.6 mmHg, and left ventricular ejection fraction 17%. Milrinone was used in 85% and dobutamine in 15% of patients. Sixty-eight patients died, 24 were weaned off inotropes, 23 were transplanted, 32 received a LVAD, and 50 remained on inotropes. Mean NYHA class decreased from 3.7 to 2.7 (p <0.001), CI increased from 1.7 L/min/m2 to 2.2 L/min/m2 (p <0.001), and PCWP decreased from 25.6 mmHg to 21.1 mmHg (p <0.001) . During follow-up, fifty-six patients (28%) had an infection related to intravenous inotropes. Thirty-three patients (16.7%) had at least one ICD shock. For the entire cohort, median survival was 18.1 months (Interquartile range [IQR] 4.7-37.1 months) and mean survival was 19.2 months (SD 1.5 months). For patients who did not receive a LVAD or transplant, median survival time was 13.2 months (IQR 3.7-37.1 months) and mean survival was 17.7 months (SD 1.5 months).
Conclusions: Survival on long term-inotropes in this study was improved compared to previous reports. Routine ICD use may mitigate some arrhythmic risks of inotropes. Inotropes may be used as a bridge to initiate standard CHF therapy and subsequently weaned in selected cases.
Author Disclosures: T. Hashim: None. K. Sanam: None. M.I. Revilla Martinez: None. C.J. Morgan: None. J.A. Tallaj: None. S.V. Pamboukian: None. R.Y. Loyaga-Rendon: None. J.F. George: None. D. Acharya: None.
- © 2014 by American Heart Association, Inc.