Quality of Life Outcomes for Patients on Palliative Cardiac Continuous Intravenous Inotropic Support

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Purpose As more patients live with advanced heart failure, use of continuous intravenous inotropic support (CIIS) as palliative therapy has increased over the last decade. However, in-depth analysis of symptom benefits provided by CIIS and its associated risks merit further investigation. We aimed to study health-related quality of life outcomes for patients receiving CIIS as palliative therapy. Methods Retrospective analysis of patients with advanced heart failure at an urban, academic center who were started on CIIS as palliative therapy between 2014-2016. Patients prescribed CIIS as bridge to surgical therapies were excluded. Data collected from the EHR included demographics, length of time on CIIS, change in functional status at first clinic appointment, and complications of therapy (e.g. ICD shocks, infections, hospitalizations, ER visits, ICU admissions). Data were analyzed using descriptive statistics. Results Seventy-six patients meeting study criteria received CIIS for palliation for an average of 6.2 months. The majority experienced improvement in functional status (69.7%) and changed code status to DNR/DNI after inotrope initiation (57.8%). Rates of ICD shocks and central line infection were 4.4 and 1.3 per 100 person-months of CIIS therapy, respectively. The rate of all cause- hospitalization was 43.6 per 100 person-months of follow up. More specifically, rate of hospitalization due to acute decompensated heart failure (ADHF), bacteremia, ICD shock, or other were 12.9, 1.1, 0, and 1.3 per 100 person-months of follow-up, respectively. Reasons for ED visits due to HF compared to non-HF related were 11.2 and 3.4 per 100 person-months, respectively. The rate of ICU admission during palliative CIIS was 5.5 per 100 person-months. Overall, patients spent 20.1% (SD 21.7%) of their time on inotropes admitted to our hospital. Conclusion Patients in this cohort reported an improvement in functional status after the initiation of CIIS. All-cause hospitalization rate was quite high in this patient cohort, with ADHF being the primary reason for hospitalization, followed by bacteremia. ICD shocks do not appear to be a major burden for these patients with respect to both rate of shocks observed and reason for hospitalization. Patients on CIIS as palliative therapy spent, on average, one out of five days in the hospital while on inotropic therapy.