PM064 The introduction of individualised milrinone doses as a cost containment strategy for heart failure patients under a hospital-in-the-home service

Abstract

O ST E R A B ST R A C T S Introduction: In patients whit advanced cardiac failure under inotropes drugs therapy(IT) the use of negative chronotropic agents like beta blockers, digoxyn or calcium blockers is very restricted Tachycardia above 100 beats pm reduce diastolic time and efficiency of intra aortic baloon conterpusation (IABP). We present our experience with oral ivabradine used to improve the efficiency of IABP in tachycardic acute heart failure patients. Objectives: To evaluate with Swan Ganz catether (SG) the hemodynamic effect of ivabradine used to reduce sinus tachycardia during IT and IABP. Methods: Between January 2011 and August 2013 were prospectively included patients in sinus rhythm with more than 100 heart beat pm admitted in to the U.A.I. critical cardiology unite with decompensated dilated ischemic cardiomyopathy. All patients treated with at least 10gmas/Kg/min of one or more IT (unchanged during measurement period). No less than 2,2 liters/m2 SG measered cardiac index. Optimized IABP setting remain unchanged durin measurement period. Were excluded patients in schock of others causes, infections, renal failure, anemia, requiring or mechanical ventilation support or whith acute digestive desease. SG measurements were performed one hour before and three hours after a single oral dosis of 15mg ivabradine. Results: The study included 22patients (12men). All whith miocardial infarction history. Age average of 65.5 years. Left ejection fraction average was 27.3%. Dose of intravenous inotropic drug average was 17.2Kg/w/min. Three hours after ivabradine heart rate decreased from 123+/-5 to 97+-5 (P0.0003) Increase cardiac output of 4452+-550 ml minute at 4925+-535 ml/min(p0.031). Increase in cardiac index without statistical significance of 2.21+/-0.3 to 2.37+/-0.3 liters/m (p0.08). The average stroke volume increased significantly from 33.9 +-5 to 52.3 +-8 ml(p0.0007). The left ventricule work index increased from 12.9 +-3 to 17.3 +-4 (p0.00003). No differences were observed in the records of right atrial pressure, wedge, systemic vascular and pulmonary resistance. After five ivabradine half-lives suspension no ecg or clinical adverse effects were observed. Conclusion: Ivabradine is useful to moderate sinus tachycardia an and improve efficiency of IABP in advanced heart failure. Ivabradine use did not interfere with IT showing an improvement in some cardiac output parameters. No changes were observed in preload and afterload parameters in this set of patients. No electrocardiographic or clinical adverse effects were observed. Disclosure of Interest: None Declared