INTERMITTENT INOTROPIC THERAPY IN AN OUTPATIENT SETTING - A COST-EFFECTIVE THERAPEUTIC MODALITY IN PATIENTS WITH REFRACTORY HEART-FAILURE

Patients with intractable heart failure (New York Heart Association [N YHA] class III and IV) who were receiving maximal conventional treatme nt were enrolled in an outpatient program that included inotropic infu sions, intensive patient education, and close follow-up. The effects o f this approach to therapy were evaluated on (1) the number of hospita l admissions, (2) length of stay, and (3) number of emergency room vis its during the ensuing year. These data were compared with similar dat a from the year before entry in the program for each patient. Thirty-s ix patients with stable NYHA class III and IV heart failure received m ilrinone or dobutamine to manage chronic heart failure in an outpatien t setting. The cause of heart failure was ischemic heart disease in 12 , idiopathic in 11, hypertension in 8, and pulmonary hypertension in 5 . Four patients received dobutamine and 32 patients received milrinone . The mean period of observation was 294 days. For the period before e ntry in the program, patients had 21 emergency room visits, 75 admissi ons, and 528 days spent in the hospital. After enrollment, patients ha d 10 emergency room visits, 34 admissions, and 150 days spent in the h ospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room v isits. Our study supports the concept that the use of intermittent ino tropic therapy in the outpatient setting plays an important role in ma naging this severely ill group of patients.