Department of Medicine, Georgetown University School of Medicine, Washington, DC; Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
Georgetown University School of Nursing & Health Studies, Washington, DC.
J Card Fail. 2021 Sep;27(9):974-980. doi: 10.1016/j.cardfail.2021.06.006. Epub 2021 Jun 19.
Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS.
We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care.
Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery.
In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.
许多患有美国心脏病学会/美国心脏协会（ACC/AHA）D 期（晚期）心力衰竭的患者在出院后会接受慢性静脉内正性肌力支持（CIIS）治疗，作为手术治疗或姑息治疗的桥梁。本研究分析了接受家庭 CIIS 治疗的晚期心力衰竭患者的临床轨迹。
我们进行了一项单中心回顾性队列研究，纳入了 2010 年至 2016 年期间接受 CIIS 治疗的患者（n=373），根据启动正性肌力支持的适应证进行分层。研究结局为从 CIIS 开始到停止治疗的时间、未接受手术治疗的患者的死亡时间以及接受姑息治疗的比例。
总体而言，患者平均接受 CIIS 治疗 5.9 个月（标准差 [SD] 7.3）。接受 CIIS 姑息治疗的患者从 CIIS 开始到死亡的平均时间为 6.2 个月（SD 6.6），而作为桥接治疗但最终未接受手术治疗的患者在平均 8.6 个月（SD 9.3）后死亡。接受 CIIS 桥接治疗的患者与接受正性肌力药物姑息治疗的患者相比，无论是否接受手术治疗，接受姑息治疗咨询的可能性明显较低。
在这个大型晚期心力衰竭患者队列中，接受 CIIS 姑息治疗的患者平均存活 6.2 个月，但患者之间存在很大差异。接受 CIIS 桥接治疗但最终未接受手术治疗的患者接受的姑息治疗较少，尽管这一亚组的死亡率很高。
