Harjai K J, Mehra M R, Ventura H O, Lapeyre Y M, Murgo J P, Stapleton D D, Smart F W
Department of Medicine, Ochsner Medical Institutions, New Orleans, LA 70121, USA.
Chest. 1997 Nov 5;112(5):1298-303. doi: 10.1378/chest.112.5.1298.
This study was conducted to assess cost savings and clinical outcomes associated with the use of home i.v. inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure.
Retrospective analysis.
Tertiary care referral center.
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 i.v. 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 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 microg/kg/min).
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 i.v. inotropic therapy.
Home i.v. 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.
本研究旨在评估晚期（纽约心脏协会[NYHA]IV级）心力衰竭患者使用家庭静脉注射正性肌力药物治疗所带来的成本节约和临床结果。
回顾性分析。
三级医疗转诊中心。
1994年5月至1996年4月期间，24例患者（13例男性，11例女性；年龄61±12岁），左心室射血分数<30%且口服药物治疗无效的心力衰竭患者需要接受至少连续4周的家庭静脉注射正性肌力药物治疗。使用的正性肌力药物包括多巴酚丁胺（n = 20；剂量5.0±2.2微克/千克/分钟）或米力农（n = 7；剂量0.53±0.05微克/千克/分钟）。
比较正性肌力药物治疗期间（研究期）和紧接的相同持续时间的前期（对照期）的护理成本和临床结果（住院次数、住院时间、NYHA功能分级）。与对照期相比，研究期（3.9±2.7个月）成本降低了16%，计算得出每位患者节省5700美元或每位患者每月节省1465美元。同时，住院次数从2.7±2.6次减少至1.3±1.3次（p = 0.056），住院时间从20.9±12.7天减少至5.5±5.4天（p = 0.0004），NYHA功能分级从4.0±0.0改善至2.7±0.9（p<0.0001）。接受家庭静脉注射正性肌力药物治疗2.8±1.7个月后，8例患者（38%）死亡。
家庭静脉注射正性肌力药物治疗可减少晚期（NYHA IV级）心力衰竭患者的住院次数、住院时间和护理成本，并改善功能分级。
