Rao Anirudh, Maini Mansi, Anderson Kelley M, Crowell Nancy A, Gholami Sherry S, Foley Lgsw Carroll, Violanti Diana, Singh Manavotam, Sheikh Farooq H, Najjar Samer S, Groninger Hunter
Georgetown University School of Medicine, Washington, DC, USA.
Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Am J Hosp Palliat Care. 2024 Jan;41(1):50-55. doi: 10.1177/10499091231160162. Epub 2023 Feb 22.
Use of continuous intravenous inotropic support (CIIS) strictly as palliative therapy for patients with ACC/AHA Stage D (end-stage) Heart Failure (HF) has increased significantly. The harms of CIIS therapy may detract from its benefits. To describe benefits (improvement in NYHA functional class) and harms (infection, hospitalization, days-spent-in-hospital) of CIIS as palliative therapy. Methods: Retrospective analysis of patients with end-stage HF initiated on CIIS as palliative therapy at an urban, academic center in the United States between 2014-2016. Clinical outcomes were extracted, and data were analyzed using descriptive statistics. Seventy-five patients, 72% male, 69% African American/Black, with a mean age 64.5 years ( = 14.5) met study criteria. Mean duration of CIIS was 6.5 months ( = 7.7). Most patients (69.3%) experienced improvement in NYHA functional class from class IV to class III. Sixty-seven patients (89.3%) were hospitalized during their time on CIIS, with a mean of 2.7 hospitalizations per patient ( = 3.3). One-third of patients (n = 25) required at least one intensive care unit (ICU) admission while on CIIS therapy. Eleven patients (14.7%) experienced catheter-related blood stream infection. Patients spent an average of 20.6% ( = 22.8), approximately 40 days, of their time on CIIS admitted to the study institution. Patients on CIIS as palliative therapy report improvement in functional class, survive 6.5 months following initiation, but spend a significant number of days in the hospital. Prospective studies quantifying the symptomatic benefit and the direct and indirect harms of CIIS as palliative therapy are warranted.
将持续静脉注射正性肌力药物支持（CIIS）严格用作美国心脏病学会/美国心脏协会（ACC/AHA）D期（终末期）心力衰竭（HF）患者的姑息治疗的情况显著增加。CIIS治疗的危害可能会削弱其益处。描述CIIS作为姑息治疗的益处（纽约心脏协会（NYHA）功能分级改善）和危害（感染、住院、住院天数）。方法：对2014年至2016年在美国一家城市学术中心开始接受CIIS作为姑息治疗的终末期HF患者进行回顾性分析。提取临床结局，并使用描述性统计方法分析数据。75名患者符合研究标准，其中72%为男性，69%为非裔美国人/黑人，平均年龄64.5岁（标准差=14.5）。CIIS的平均持续时间为6.5个月（标准差=7.7）。大多数患者（69.3%）的NYHA功能分级从IV级改善到III级。67名患者（89.3%）在接受CIIS治疗期间住院，平均每位患者住院2.7次（标准差=3.3）。三分之一的患者（n = 25）在接受CIIS治疗期间至少需要入住一次重症监护病房（ICU）。11名患者（14.7%）发生了导管相关血流感染。患者在接受CIIS治疗期间平均有20.6%（标准差=22.8），约40天，在研究机构住院。接受CIIS作为姑息治疗的患者报告功能分级有所改善，开始治疗后存活6.5个月，但住院天数较多。有必要进行前瞻性研究，以量化CIIS作为姑息治疗的症状性益处以及直接和间接危害。
