A prospective study of continuous intravenous milrinone therapy for status IB patients awaiting heart transplant at home

Brozena, Susan C.; Twomey, Carol; Goldberg, Lee R.; Desai, Shashank; Drachman, Brian; Kao, Andrew; Popjes, Eric; Zimmer, Ross; Jessup, Mariell

doi:10.1016/j.healun.2003.08.017

Cited by 60 publications

(29 citation statements)

References 20 publications

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“…17 For heart transplant candidates, home inotropes are useful and cost effective compared with hospitalization. 18,19 For some patients with end-stage HF, quality of life may be more important than quantity of life, and inotropes can be used for palliative care. 20 In light of the existing evidence, the 2013 guidelines from American College of Cardiology/American Heart Association recommend temporary intravenous inotropes for patients with cardiogenic shock until definite therapy or resolution of the precipitating problem (class I, level of evidence C), as a bridge to transplant or LVAD in candidates with refractory symptoms on oral and device therapy (class IIa, level of evidence C), and state that inotropes can be considered for palliative therapy or in hospitalized patients with low output state (class IIb, level of evidence B).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Hashim

Sanam

Revilla-Martinez

et al. 2015

Circ: Heart Failure

115

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Background-Inotrope use in heart failure treatment was associated with improved symptoms, but worse survival in clinical trials. However, these studies predated use of modern heart failure therapies. This study evaluates contemporary outcomes on long-term inotropes. Methods and Results-We collected baseline and postinotrope data on 197 patients discharged on inotropes between January 2007 and March 2013. Baseline characteristics, hemodynamic and clinical changes on inotropes, and survival were evaluated. Patients initiated on inotropes had refractory heart failure, with median baseline New York Heart Association class IV, cardiac index of 1.7 L/min per m 2 , pulmonary capillary wedge pressure of 25.6 mm Hg, and left ventricular ejection fraction of 18.7%. Inotropes were used in patients listed for transplant or scheduled for left ventricular assist device (LVAD; 60 patients), in patients being evaluated for LVAD/transplant (20 patients), for stabilization pending cardiac resynchronization therapy/percutaneous coronary intervention (4 patients), in patients who were offered LVAD but chose inotropes (15 patients), and for palliation (98 patients). Milrinone was used in 84.8% and dobutamine in 15.2%. At the end of the study, 68 patients had died, 24 were weaned off inotropes, 23 were transplanted, 32 received LVADs, and 50 remained on inotropes. Patients who received inotropes for palliation or those who preferred inotropes over LVAD had median survival of 9.0 months (interquartile range, 3.1-37.1 months), actuarial 1-year survival of 47.6%, and 2-year survival of 38.4%. Of 60 patients who were placed on inotropes as a bridge to transplant/LVAD, 55 were successfully maintained on inotropes until transplant/LVAD. Conclusions-Survival on inotropes for patients who are not candidates for transplant/LVAD is modestly better than previously reported, but remains poor. Inotropes are effective as a bridge to transplant/LVAD. (Circ Heart Fail.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Hashim

Sanam

Revilla-Martinez

et al. 2015

Circ: Heart Failure

115

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“…Positive inotropic therapy has been shown to improve symptoms and functional ability [14][15][16], and continuous outpatient support with inotropes (COSI) has been used as support for patients awaiting transplantation and as well as palliative therapy for patients dying of refractory heart failure [14][15][16][17][18][19]. In our program, the use of COSI as palliative therapy in inotrope-dependent patients resulted in a median survival of 3.2 months [5] (Fig.…”

Section: Introductionmentioning

confidence: 91%

The use of positive inotropes in end-of-life heart failure care

Nauman

2007

Curr Heart Fail Rep

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End-stage heart failure is associated with mortality equivalent to cancer, yet there is little information about palliative therapy for this disease. Chronic outpatient support with inotropes provides symptomatic relief and life extension for those select patients demonstrating dependence on positive inotropic therapy. The purpose of this review is to provide information about process and implementation of chronic outpatient support with inotropes in patients with end-stage heart failure.

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“…Noninvasive imaging to detect myocardial ischemia and viability is reasonable in HF and CAD IIa C Viability assessment is reasonable before revascularization in HF patients with CAD IIa B [281][282][283][284][285] Radionuclide ventriculography or MRI can be useful to assess LVEF and volume IIa C MRI is reasonable when assessing myocardial infiltration or scar IIa B [286][287][288] Routine repeat measurement of LV function assessment should not be performed III: No Benefit B e258 Circulation…”

Section: Noninvasive Cardiac Imaging: Recommendationsmentioning

confidence: 99%

“…303 Although the results of the STICH (Surgical Treatment for Ischemic Heart Failure) trial have cast doubt on the role of myocardial viability assessment to determine the mode of therapy, 304 the data are nevertheless predictive of a positive outcome. When these data are taken into consideration with multiple previous studies demonstrating the usefulness of this approach, [281][282][283][284][285] it becomes reasonable to recommend viability assessment when treating patients with HFrEF who have known CAD. 14 See Online Data Supplement 9 for additional data on imaging−echocardiography.…”

Section: October 15 2013mentioning

confidence: 99%