Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure

Hershberger, Ray E.; Nauman, Deirdre; Walker, Tracy L.; Dutton, Diana Barbara; Burgess, Donna

doi:10.1054/jcaf.2003.24

Cited by 221 publications

(140 citation statements)

References 26 publications

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“…Conversely, among participants who were more willing to undergo intensive intervention, participants with HF were most likely to receive more highly intensive care, which may reflect the availability of interventions even for the most advanced HF. 32 The inability to offer a treatment plan to meet the preferences of certain patients with advanced disease who continue to desire lifeprolongation suggests that honoring treatment preferences may frequently not be possible and therefore may not be a good marker of the quality of end-of-life care. The findings of this study also support the notion that advance care planning should include issues other than treatment preferences that have been shown to be important to patients, such as increasing patients' sense of control and decreasing burden on others.…”

Section: 16mentioning

confidence: 99%

The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

et al. 2007

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Section: 16mentioning

confidence: 99%

The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

et al. 2007

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“…Several recent studies have demonstrated that patients with HF severity of illness sufficient to require inotropes have mortality rates of nearly 80% at 2 years. 18,19 Nevertheless, extended intravenous inotropic therapy is frequently used among patients with end-stage HF who are undergoing consideration for advanced therapies to reduce symptom burden and to decrease hospitalizations. In this case, it would be reasonable to initiate milrinone infusion to treat the symptoms associated with low cardiac output and to move toward listing for cardiac transplantation given his intermediate-term risk for death.…”

Section: Dr Rogersmentioning

confidence: 99%

When the Heart Runs Out of Heartbeats

et al. 2012

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A 50-year-old man was referred to the Advanced Heart Failure clinic at our institution for consideration of additional treatment options. He was diagnosed with heart failure (HF) 4 years earlier. Transthoracic echocardiography revealed a dilated left ventricle (LV) with an LV end-diastolic dimension of 5.5 cm, globally depressed ejection fraction (EF; estimated at 30%), and moderate mitral regurgitation. Complete blood cell count, urinalysis, and liver function tests were normal. Screening for hemochromatosis, human immunodeficiency virus, rheumatologic disease, and amyloidosis was performed and was negative. He did not have a family history of cardiomyopathy or sudden cardiac death. Coronary angiography revealed no evidence of obstructive coronary artery disease. Right heart catheterization demonstrated a right atrial pressure of 15 mm Hg, pulmonary artery pressure of 41/21 mm Hg, pulmonary capillary wedge pressure of 20 mm Hg, and cardiac index of 2.3 L ⅐ min ؊1 ⅐ m ؊2 . He was started on evidence-based therapies for HF. An implantable cardioverter-defibrillator was placed for primary prevention of sudden cardiac death after no improvement in his EF. He was not considered a candidate for cardiac resynchronization therapy because his QRS duration was 100 milliseconds. He had progressive HF symptoms despite maximal medical therapy and was hospitalized 3 times during the 6 months before referral for acute decompensated HF. The doses of angiotensin-converting enzyme inhibitor and ␤-blocker had been recently reduced by his cardiologist secondary to lightheadedness and fatigue accompanied by hypotension. His medical history was remarkable for hypertension and dyslipidemia. He reported adherence to his prescribed medications that included carvedilol 6.25 mg twice daily, lisinopril 5 mg daily, spironolactone 25 mg daily, and furosemide 40 mg daily.Dr Rogers: It is timely to refer this patient for advanced HF therapies because these therapies improve functional status and long-term prognosis of patients with refractory HF. 1 Referral is appropriate not only for potential heart transplantation or mechanical circulatory support (MCS) but also for medical management of persistent functional class III and IV symptoms. 2 The clinical history suggests that this patient has an idiopathic nonischemic cardiomyopathy with persistent symptomatic HF. He has been treated with angiotensinconverting enzyme inhibitors and ␤-blockers, therapies that form the cornerstone of treatment to delay or halt the progression of cardiac dysfunction and improve mortality. Aldosterone antagonists are also recommended for patients with New York Heart Association class III to IV HF secondary to reduced LVEF (Ͻ35%). Diuretic therapy, although not associated with improvement in outcomes, is recommended to restore and maintain normal volume status. 3 In this case, the history of frequent hospitalizations and reductions in neurohormonal antagonists doses for hypotension are markers of poor prognosis and suggest that the illness is progressing despite opt...

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“…In the Western world, most heart failure is related to coronary disease, and although the survival of patients post acute myocardial infarction has improved, this has resulted in an increase in the number of patients ultimately developing heart failure 2 . Advances in medical therapy have resulted in improved survival in patients with moderate and severe heart failure, but the prognosis for end-stage heart failure patients remains poor [3][4][5] . In patients with end-stage heart failure cardiac transplantation remains the gold standard of cardiac replacement therapy and it has shown the greatest survival benefit.…”

Section: Introductionmentioning

confidence: 99%