The value of intermittent inotropic therapy in unhospitalized patients with refractory heart failure

Abstract

The treatment of intractable heart failure (New York Heart Association--NYHA IV) with inotropic support is a well established adjunct in the control of clinical status of end-stage heart failure patients but usually needs many admissions and a long period of hospitalization. In this study we report on the follow-up findings of 64 patients for 18 months who were seen in an outpatients congestive heart failure program. All patients had their full standard oral drug treatment, received intensive patient teaching and weekly inotropic infusions. We assess the effects of this comprehensive therapeutic approach on: 1) the number of hospital admissions, 2) length of stay and 3) the number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. All our patients showed NYHA class IV heart failure and received dobutamine to manage their chronic heart failure in an outpatient setting. The cause of heart failure was ischaemic in 34 (53.12%), idiopathic in 14 (21.87%), hypertension in 10 (15.62%), pulmonary hypertension in 7 (10.93%) and valvular heart disease in 6 (9.37%) patients. The mean period of observation was 382 days. For the period before entry in the program patients had 67 emergency room visits, 184 admissions, and 832 days spent in the hospital. After enrollment all these figures significantly decreased (p<0.001), patients heading 35 emergency room visits, 112 admissions and 518 days spent in the hospital. In conclusion, the intermittent inotropic therapy as an outpatient setting may be a valuable cost-effective therapeutic method, in patients with refractory heart failure and is associated with the reduction of emergency room visits, admissions and days spent in the hospital.