[Infusion therapy at outpatient clinic in chronic end-stage heart failure].
OBJECTIVE
To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization.


METHODS
Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr).


RESULTS
Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005.


CONCLUSIONS
Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option.
Nishi
Kiyoto
K
Division of Cardiology, Hyogo Prefectural Amagasaki Hospital, Higashidaimotsucho 1-1-1, Amagasaki, Hyogo.
Sato
Yukihito
Y
Miyamoto
Tadashi
T
Taniguchi
Ryoji
R
Matsuoka
Tatsuhiko
T
Kuwabara
Yasuhide
Y
Isoda
Kei
K
Yamane
Keiichirou
K
Hatakenaka
Tsutomu
T
Fujinaga
Keiko
K
Fujiwara
Hisayoshi
H
Takatsu
Yoshiki
Y
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage; D001794:Blood Pressure; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*
C472955:NPPA protein, human; D010726:Phosphodiesterase Inhibitors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor