Objectives: 1) To determine clinical characteristics and end-of-life experiences for patients receiving continuous inotrope therapy referred to hospice care; 2) to determine hospice clinician attitudes and clinical experiences providing care for these inotrope-dependent AHF patients. Methods: We retrospectively reviewed hospitalized AHF patients receiving PC consultation who were discharged with hospice services on continuous inotropes. All hospices received inotrope-weaning guidelines to use as indicated. Data collected included patient AHF disease characteristics, symptomatology, inotrope therapy course, and inotrope plan at discharge. We also surveyed hospice clinicians regarding inotrope therapy in hospice plan-of-care. Descriptive statistics were used to analyze data. Results: Between March 2015 and March 2016, 10 AHF patients (median age 62 years, 70% non-ischemic cardiomyopathy, 80% with implantable cardioverter-defibrillators) were discharged to hospice at 4 different agencies. Patients received care in both inpatient (n¼5) and outpatient (n¼5) settings with either milrinone (n¼8) or milrinone plus dobutamine (n¼2). All received hospice care ¼72 hours, and 5 received for >14 days. Four patients were weaned from inotropes and survived > 48 hours from time of inotrope discontinuation. Three clinicians used the inotrope weaning guidelines and found them helpful. Three patients had inotropes discontinued without weaning and survived for at least 24 hours after discontinuation. Three patients continued inotrope therapy until death. All hospice providers said they would accept other patients on continuous inotropes. Conclusion: Inotropes can be safely weaned or discontinued for patients with AHF receiving hospice care. Predicting survivability and symptomatology after inotrope discontinuation requires further investigation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.