Inotropic support in palliative patients with advanced heart failure
Abstract:
Background: The use of continuous intravenous inotropic support (CIIS) as palliative therapy in patients with advanced heart failure (HF) has increased over the past decade. CIIS improves New York Heart Association (NYHA) functional class but does not impact survival.
Objective: The objective of this study was to examine patients’ understanding of the therapeutic intent of CIIS, prognostic awareness, and quality of life with CIIS.
Design: We conducted a prospective, cross-sectional, multicenter study of patients with advanced HF receiving CIIS as palliative therapy between 2020 and 2022.
Settings/Subjects: An investigator-developed survey instrument was administered to outpatients on CIIS in the United States via telephone.
Measurements: Survey data were analyzed using descriptive and inferential statistics.
Results: Forty-eight patients, 63% male, 81% African American/Black, with a mean age of 68.9 (standard deviation 12.3) years, participated in this study. The majority of patients responded that they expected CIIS to make them feel better (79%) and increase longevity (75%), but few expected that CIIS would cure their HF (19%). Patients described their overall quality of life on CIIS as not better/worse (19%), somewhat better (46%), and significantly better (35%) and reported high treatment satisfaction (87% were at least somewhat satisfied).
Conclusions: In this study, patients report improved quality of life with CIIS as palliative therapy. Patients on CIIS as palliative therapy expected increased survival on CIIS, which is incongruent with current evidence. Further studies on how we can improve care processes so that patients have accurate prognostic and disease-state awareness, and receive goal concordant care, are warranted.
Reference:
Maini M, Anderson KM, Seplowe M, Crowell NA, Pitcher C, Scally R, Weintraub WS, Najjar SS, Groninger H, Rao A. Disease-State Understanding and Experience of Patients Receiving Continuous Intravenous Inotropic Support as Palliative Therapy: A Multicenter Survey. J Palliat Med. 2024 Apr 1. doi: 10.1089/jpm.2023.0670. Epub ahead of print. PMID: 38564223.