Chest
Volume 112, Issue 5, November 1997, Pages 1298-1303
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Clinical Investigations: Miscellaneous
Home Inotropic Therapy in Advanced Heart Failure: Cost Analysis and Clinical Outcomes

https://doi.org/10.1378/chest.112.5.1298Get rights and content

Study objectives

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

Design

Retrospective analysis.

Setting

Tertiary care referral center.

Patients and interventions

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 IV 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 μg/kg/min) or milrinone (n=7; dose, 0.53±0.05 μg/kg/min).

Measurements and 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 IV inotropic therapy.

Conclusions

Home IV 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.

Section snippets

Patients

Twenty-four patients with advanced HF who received HIIT for at least 4 consecutive weeks were included in the study. The study population consisted of 13 men and 11 women with a mean age of 61±12 years and a left ventricular ejection fraction <30%;. HIIT had been instituted in these patients between May 1994 and April 1996 for refractory HF. The etiology of left ventricular dysfunction was ischemic (n=14; 58%;), idiopathic (n=8; 33%;), post partum (n=l; 4%;), or alcohol-induced (n=l, 4%;)

Cost of Care

Total cost per month during the control period tended to be lower among patients who received intermittent inotropic therapy ($10,500±$10,800) vs those who received continuous inotropic therapy ($15,500±$8,700; p=0.06).

A comparison of hospitalization, outpatient, home health care, and total costs during study and control periods is shown in Table 3. During the study period, compared to the control period, a significant reduction was seen in hospital cost (p=0.0007) with no change in outpatient

DISCUSSION

This study elucidates the fact that the use of HIIT in patients with advanced HF is associated with a significant reduction in the length of hospital stay, with concomitant improvement in NYHA class. In our analysis, improvement in clinical parameters was achieved along with a significant reduction in hospitalization costs and an economically substantial, but statistically nonsignificant, reduction in overall costs. The mean total cost saving was 16%; when compared to cost incurred during the

CONCLUSIONS

A strategy utilizing HIIT in patients with advanced HF refractory to oral agents is associated with significant improvement in functional class and reduction in admissions and length of hospital stay, and at the same time, leads to a reduction in total cost of care. These findings might have significant implications on the health-care budget in an era of cost containment. Therefore, although the effect of such a strategy on mortality is uncertain, it is a feasible option in patients with

REFERENCES (11)

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Reprint requests: Frank W. Smart, MD, Medical Director, Transplantation, Ochsner Medical Institutions, 1514 Jefferson Highway, New Orleans, LA 70121

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