ACCEPTANCE OF A PUMP-DRIVEN INFUSION THERAPY WITH PROSTAGLANDIN E(1) AS A BRIDGE TO HEART-TRANSPLANTATION

Ambulatory pump-driven intravenous infusions are a novel and - compare d with hospitalization - cost-effective procedure to bridge refractory heart failure patients to cardiac transplantation. In the present stu dy 13 patients received chronic infusions with prostaglandin E(1) alon e or in conjunction with catecholamines and the acceptance of this bri dging therapy was investigated over a period of seven weeks. Prostagla ndin E(1) was uptitrated from 2.5 ng/kg/min to a maximum of 40 ng/kg/m in, according to individual tolerance. 50% of the maximum tolerated do se of prostaglandin E(1) was used for chronic infusion with a further dose reduction if side effects occurred. Altogether 8 patients who com pleted the therapy were analysed; of the remaining 5 three patients ha d a heart transplant, one patient died and one patient did not comply with the protocol. The drugs were administered by an automatic portabl e pump, which was connected to a subcutaneous tunneled catheter. Durin g hospitalization patients and their relatives were instructed how to prepare drug solutions and to handle the infusion system. Patients' pe rceptions were investigated by visual analog scale questionnaires (rat ing scale zero to ten) before, and at weekly intervals during bridging therapy. Initial acceptance was documented as belief in therapy (9.4 +/- 1.2 SD), absence of fear of handling the pump (8.9 +/- 1.2 SD) and confidence of receiving help of close relatives (8.7 +/- 1.8 SD). Dur ing the observation period there were no statistically significant dif ferences compared with this favorable starting position and no signifi cant disruption of life style occurred. Pain in the joints - a prostag landin E(1)-associated side effect - increased significantly (p<0.05) at week 5, but returned to baseline levels during the following two we eks. At study end patients confirmed that they would repeat the experi ence (7.6 +/- 1.4 SD) and advise other patients to undergo this form o f therapy (8.2 +/- 1.9 SD). Thus, this pilot study suggests that ambul atory pump-driven intravenous infusion therapy comprising prostaglandi n E(1) and catecholamines is acceptable to patients as a bridge to hea rt transplantation and that there should be no major difficulties rega rding compliance.