Failing heart—medical aspectsHome continuous positive inotropic infusion as a bridge to cardiac transplantation in patients with end-stage heart failure☆
Section snippets
Study population
We studied 21 consecutive patients who were maintained on continuous intravenous positive inotropic therapy at home while awaiting cardiac transplantation at UNOS status 1B between February 1999 and January 2002. All patients successfully weaned from positive inotropic therapy while receiving standard oral medical therapy for heart failure. Patients were discharged home from the hospital if they were clinically stable in New York Heart Association Class III or better while receiving stable
Clinical characteristics
We studied 12 men and 9 women with a mean age of 52 years (range, 30–63 years). The mean ejection fraction was 21% ± 2% (range, 10%–52%. The cause of left ventricular dysfunction was underlying ischemic heart disease in 9 patients and non-ischemic in 12 patients (idiopathic dilated cardiomyopathy in 8 patients, non-compaction cardiomyopathy in 1 subject, Adriamycin-induced cardiomyopathy in 1 subject, post-partum cardiomyopathy in 1 subject, and hypertrophic cardiomyopathy in 1 subject).
Discussion
In this series of 21 patients with end-stage heart disease, continuous, long-term positive inotropic therapy at home was associated with improved clinical status, improved renal function, decreased hospitalizations, sustained improvement in resting hemodynamics, decreased health care costs, and increased rate of survival until transplantation.
The use of ambulatory, continuous positive inotropic infusions for treating end-stage heart failure was first proposed soon after the introduction of
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Home Milrinone in Pediatric Hospice Care of Children with Heart Failure
2023, Journal of Pain and Symptom ManagementLong-Term Ambulatory Intravenous Milrinone Therapy in Advanced Heart Failure
2022, Heart Lung and CirculationCitation Excerpt :They did not, however, compare them to the pre milrinone status. Other studies either had a small number of patients [7,11], had patients receiving both milrinone and dobutamine [11,18], were done on inpatient populations [20] or registry data with limited laboratory and haemodynamic values [21], measured only complications or survival [21,22], or did not report these data separately for milrinone subset [7,11,18] making the data of limited value in terms of clinical application or generalisability. Overall, our results are largely consistent with prior ambulatory IV inotrope studies; however, they provide support for these previous limited studies and confirms their generalisability to IV milrinone.
Current Status of Inotropes in Heart Failure
2018, Heart Failure ClinicsAmbulatory Inotrope Infusions in Advanced Heart Failure: A Systematic Review and Meta-Analysis
2018, JACC: Heart FailureImpact of Advanced Therapies for Improving Survival to Heart Transplant in Patients with Hypertrophic Cardiomyopathy
2018, American Journal of CardiologyOutpatient Management of Pediatric HF
2018, Heart Failure in the Child and Young Adult: From Bench to Bedside
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Supported in part by National Heart, Lung, and Blood Institute Grant HL K24-04024 (SDK).