Anirudh Rao1, Kelley M Anderson2, Selma Mohammed3, Mark Hofmeyer4, Sherry S Gholami5, Farooq H Sheikh4, Maria E Rodrigo4, Nancy A Crowell2, Hasan Javed4, Shantal Gupta4, Said Hajouli6, Diana E Stewart7, Ahmad Hamad8, Samer S Najjar4, Hunter Groninger9. 1. Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC. Electronic address: anirudh.rao@medstar.net. 2. Georgetown University School of Nursing & Health Studies, Washington, DC. 3. Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska. 4. Advanced Heart Failure Program, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC. 5. Department of Medicine, Georgetown University School of Medicine, Washington, DC. 6. Department of Medicine, Logan Regional Medical Center, Logan, West Virginia. 7. Department of Medicine, Buffalo General Medical Center, Buffalo, New York. 8. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 9. Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
Abstract
BACKGROUND: Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. METHODS: We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. RESULTS: Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. CONCLUSIONS: In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.
BACKGROUND: Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. METHODS: We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. RESULTS: Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. CONCLUSIONS: In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.
Authors: Anirudh Rao; Manavotam Singh; Mansi Maini; Kelley M Anderson; Nancy A Crowell; Paul R Henderson; Sherry S Gholami; Farooq H Sheikh; Samer S Najjar; Hunter Groninger Journal: Front Cardiovasc Med Date: 2022-08-30