Home inotropic therapy in advanced heart failure: cost analysis and clinical outcomes.
OBJECTIVE
This study was conducted to assess cost savings and clinical outcomes associated with the use of home i.v. inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure.


METHODS
Retrospective analysis.


METHODS
Tertiary care referral center.


METHODS
Twenty-four patients (13 men, 11 women; age, 61+/-12 years) with left ventricular ejection fraction <30% and heart failure refractory to oral agents required home i.v. inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0+/-2.2 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 microg/kg/min).


RESULTS
Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9+/-2.7 months) was associated with a 16% reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7+/-2.6 to 1.3+/-1.3 (p=0.056) and length of hospital stay from 20.9+/-12.7 to 5.5+/-5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0+/-0.0 to 2.7+/-0.9 (p<0.0001). Eight patients (38%) died after 2.8+/-1.7 months of home i.v. inotropic therapy.


CONCLUSIONS
Home i.v. inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.
Harjai
K J
KJ
Department of Medicine, Ochsner Medical Institutions, New Orleans, LA 70121, USA.
Mehra
M R
MR
Ventura
H O
HO
Lapeyre
Y M
YM
Murgo
J P
JP
Stapleton
D D
DD
Smart
F W
FW
D002316:Cardiotonic Agents / Q000191:economics* / Q000627:therapeutic use; D002423:Cause of Death; D003365:Costs and Cost Analysis; D004180:Direct Service Costs; D004280:Dobutamine / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020105:Milrinone; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D015996:Survival Rate; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D011728:Pyridones; D004280:Dobutamine; D020105:Milrinone