Effects of intravenous home dobutamine in palliative end-stage heart failure on quality of life, heart failure hospitalization, and cost expenditure

Abstract

AimsIn patients with palliative end-stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital stay, mortality, and cost expenditure. Methods and resultsAll consecutive end-stage heart failure patients not amenable for advanced therapies and discharged with continuous intravenous home dobutamine from a single tertiary centre between April 2011 and January 2017 were retrospectively analysed. Dobutamine (fixed dose) was infused through a single-lumen central venous catheter with a small pump that was refilled by a nurse on a daily basis. Symptomatic status was longitudinally assessed as the change in New York Heart Association class and patient global assessment scale. Antecedent and incident heart failure hospitalizations were determined in a paired fashion, and cost impact was assessed. A total of 21 patients (age 779years) were followed up for 869 +/- 647days. At first follow-up (6 +/- 1weeks) after the initiation of dobutamine, patients had a significant improvement in New York Heart Association class (-1.29 +/- 0.64; P<0.001), global assessment scale (<0.001), and N-terminal pro-brain natriuretic peptide (6247 vs. 2543pg/mL; P=0.033). Incident heart failure hospitalizations assessed at 3, 6, and 12months were significantly reduced (P<0.001 for all) in comparison with antecedent heart failure hospitalizations over the same time period. Cost expenditure was significantly lower at 3 (P<0.001), 6 (P=0.005), and 12months (P=0.001) after initiation of dobutamine. Mortality rate at 1year was 48% with 9/12 (75%) patients dying at home, most often from progressive pump failure. ConclusionsContinuous intravenous home dobutamine in patients with palliative end-stage heart failure is feasible and associated with improved symptomatic status, heart failure hospitalizations, and health-care-related costs. Nevertheless, results should be interpreted in the context of the small and retrospective design. Larger studies are necessary to evaluate the effect of dobutamine in palliative end-stage heart failure.