Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 10;10(12):2571.
doi: 10.3390/jcm10122571.

Outcome Predictors and Safety of Home Dobutamine Intravenous Infusion in End Stage Heart Failure Patients

Antoine Jobbé-Duval  1 , Thomas Bochaton  2 , Guillaume Baudry  1 , Eric Bonnefoy-Cudraz  2 , Elisabeth Hugon-Vallet  1 , Matteo Pozzi  3 , Jean-Francois Obadia  3 , Danka Tomasevic  2 , Camille Amaz  4 , Nathan Mewton  1   4 , Laurent Sebbag  1
Affiliations

Outcome Predictors and Safety of Home Dobutamine Intravenous Infusion in End Stage Heart Failure Patients

Antoine Jobbé-Duval et al. J Clin Med. .

Abstract

Patients in end-stage heart failure can experiment cardiogenic shock and may not be weanable from dobutamine. The fate of these patients is a challenge for doctors, patients, family, and the institution. Dobutamine use at home can be a solution. The aim of the present study was to assess the outcome, biological predictors, and safety of dobutamine use at home in dobutamine-dependent patients. All consecutive dobutamine-dependent patients discharged with continuous home intravenous dobutamine, from a single tertiary center between February 2014 and November 2019, were retrospectively analyzed. A total of 19 patients (age 65 ± 10 years) were followed for one year. At one-year, the survival rate was 32%, (6/19). Five (26%) patients had an adverse event related to the intravenous catheter. In a multivariate logistic regression analysis, the combination of a glomerular filtration rate >60 mL/min and a brain natriuretic peptide level <1000 ng/L, were highly predictive of one-year survival (HR = 10.87, IC95% (5.78-36.44), p < 0.001). Management of dobutamine-unweanable patients after cardiogenic shock may involve dobutamine at home to permit a home return. This strategy allows a significant survival and few readmissions, and, if eligible, access to surgical strategies, such as heart transplantation. Simple biological markers at discharge can identify severe patients to refer to palliative care and good responders.

Keywords: end-stage heart failure; home dobutamine; mortality; safety.

PubMed Disclaimer

Conflict of interest statement

A.J.-D. has received grant and/or consultant fees from NOVARTIS, AMICUS, SANOFI-GENZYME, BOEHRINGER-INGELHEIM.

Figures

Figure 1
Figure 1
Event-free survival in the whole study population.
Figure 2
Figure 2
Event-free survival in the patient group with BNP > 1000 ng/L and GFR < 60 mL/min and all other patients from the cohort. An event was defined as all cause death.
Figure 3
Figure 3
Receiver operating characteristic curves representing modelization of one-year mortality by GFR and BNP, adjusted for diabetes and FEVG.
See this image and copyright information in PMC

References

    1. Fang J.C., Ewald G.A., Allen L.A., Butler J., Canary C.A.W., Colvin-Adams M., Dickinson M.G., Levy P., Stough W.G., Sweitzer N.K., et al. Advanced (Stage D) Heart Failure: A Statement From the Heart Failure Society of America Guidelines Committee. J. Card. Fail. 2015;21:519–534. doi: 10.1016/j.cardfail.2015.04.013. - DOI - PubMed
    1. Stevenson L.W., Pagani F.D., Young J.B., Jessup M., Miller L., Kormos R.L., Naftel D.C., Ulisney K., Desvigne-Nickens P., Kirklin J.K. INTERMACS Profiles of Advanced Heart Failure: The Current Picture. J. Heart Lung Transplant. 2009;28:535–541. doi: 10.1016/j.healun.2009.02.015. - DOI - PubMed
    1. Martens P., Vercammen J., Ceyssens W., Jacobs L., Luwel E., Van Aerde H., Potargent P., Renaers M., Dupont M., Mullens W. Effects of intravenous home dobutamine in palliative end-stage heart failure on quality of life, heart failure hospitalization, and cost expenditure. ESC Heart Fail. 2018;5:562–569. doi: 10.1002/ehf2.12248. - DOI - PMC - PubMed
    1. Lang C.C., Hankins S., Hauff H., Maybaum S., Edwards N., Mancini D.M. Morbidity and mortality of UNOS status 1B cardiac transplant candidates at home. J. Heart Lung Transplant. 2003;22:419–426. doi: 10.1016/S1053-2498(02)00570-3. - DOI - PubMed
    1. Hershberger R.E., Nauman D., Walker T.L., Dutton D., Burgess D. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory endstage heart failure. J. Card. Fail. 2003;9:180–187. doi: 10.1054/jcaf.2003.24. - DOI - PubMed