Chronic inotropic therapy in end-stage heart failure.
BACKGROUND
Interventions in advanced heart failure that provide symptom relief and decrease hospital readmission are important. Chronic intravenous inotropic therapy represents a pharmacologic approach that has been advocated for palliative treatment. However, little is known about associated mortality and cost. Therefore, we sought to describe the impact of chronic infusions on resource use and survival.


METHODS
Data were reviewed for a 17-state Medicare region from 1995 to 2002. We obtained hospital and outpatient expenditures accrued up to 180 days before and after the initiation of chronic infusions. Health care use was defined by dollars reimbursed for drug and hospitalizations per beneficiary. Average accumulated cost curves were generated for dollars reimbursed for drug and for hospitalizations by days at risk.


RESULTS
The mean age of the cohort (n = 331) was 69.1 +/- 11.3 years. Mortality exceeded 40% at 6 months. Reductions in hospital days were observed at all time points. The amounts reimbursed at 30 and 60 days before and after initiation of inotrope favor drug therapy; however, at six months, the amounts reimbursed were greater due to the cost of milrinone.


CONCLUSIONS
Chronic intravenous inotrope use was associated with a high mortality. The cost for milrinone was significant, but there was a decrease in expenditures for subsequent hospitalizations. In the absence of appropriately designed clinical trials, the data suggest that the decision to use inotropes, the choice of inotrope, and the duration of treatment should reflect the impact on resource use.
Hauptman
Paul J
PJ
Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA. hauptmpj@slu.edu
Mikolajczak
Peter
P
George
Anil
A
Mohr
Clinton J
CJ
Hoover
Robert
R
Swindle
Jason
J
Schnitzler
Mark A
MA
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors
D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone