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.
Highlights
Despite all the progress made in heart failure therapies, up to 10% of heart failure patients progress towards advanced and end-stage heart failure
This study is a retrospective study of all patients with advanced or end-stage heart failure (Intermacs 3 Stage) discharged from a single tertiary referral center with intravenous home dobutamine (IHD)
IHD was applied to two different groups of end-stage heart failure patients: the bridge to therapy (BTTh) group, where IHD was placed transiently pending a surgical intervention or an advanced therapy or the destination therapy (DT) group, in patients not eligible for advanced therapy, in a palliative setting
Summary
Despite all the progress made in heart failure therapies, up to 10% of heart failure patients progress towards advanced and end-stage heart failure. At this stage, patients are symptomatic, refractory to medical treatment optimization according to guidelines and have a poor quality of life [1]. They are classified by the Intermacs scale at the Intermacs 3 stage [2], stable under inotropic drugs The outcome of these patients is challenging, as they are stabilized by the inotropic treatment but stranded in hospital by the continuous central venous administration of the treatment accompanied by daily nursing supervision
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