Chest
Clinical Investigations: MiscellaneousHome Inotropic Therapy in Advanced Heart Failure: Cost Analysis and Clinical Outcomes
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
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Cited by (52)
Long-Term Ambulatory Intravenous Milrinone Therapy in Advanced Heart Failure
2022, Heart Lung and CirculationCitation Excerpt :Upadya et al. reported that hospitalisations reduced from 40 in 12 months prior to 18 after initiating inotrope therapy in the mean 3–9-month follow-up period of the study [11]. Although study by Harjai et al. failed to show a decrease in the number of hospital admissions (p=0.48), it did show a significant decrease in the length of hospital stay (p=0.004) in their subset analysis of patients receiving continuous inotropes as opposed to intermittent infusion [7]. Hauptman et al. studied 331 patients on inotropes (milrinone or dobutamine or both with therapy changed from one inotrope to other during study period) and reported a decrease in the mean hospitalised days per patient per month (13.9–4.7 at 30 days, 8.9–4.4 at 60 days, 4.3–2.7 at 6 months) without commenting on significance or subset of only milrinone [18].
Heart Failure: A Palliative Medicine Review of Disease, Therapies, and Medications With a Focus on Symptoms, Function, and Quality of Life
2020, Journal of Pain and Symptom ManagementCurrent Status of Inotropes in Heart Failure
2018, Heart Failure ClinicsOutpatient Management of Pediatric HF
2018, Heart Failure in the Child and Young Adult: From Bench to BedsideClinical Decision Support to Efficiently Identify Patients Eligible for Advanced Heart Failure Therapies
2017, Journal of Cardiac FailureCitation Excerpt :The IH specialized HF facilities attribute their success to the use of a coordinated multidisciplinary team, constant patient follow-up assisted by CDS, and home care with experience in advanced HF. Skilled home nursing care is required in the treatment of advanced HF patients, and the home care nurse plays a major role in their outcome.35,36 To derive maximal benefit from all available therapies, HF disease management with collaboration of physicians and specialized nurses offers the greatest benefit to the greatest number of patients with advanced HF.37
Outpatient Management of Pediatric HF
2017, Heart Failure in the Child and Young Adult: From Bench to Bedside
Reprint requests: Frank W. Smart, MD, Medical Director, Transplantation, Ochsner Medical Institutions, 1514 Jefferson Highway, New Orleans, LA 70121