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 [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluated on (1) the number of hospital admissions, (2) length of stay, and (3) number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. Thirty-six patients with stable NYHA class III and IV heart failure received milrinone or dobutamine to manage chronic heart failure in an outpatient 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 entry in the program, patients had 21 emergency room visits, 75 admissions, and 528 days spent in the hospital. After enrollment, patients had 10 emergency room visits, 34 admissions, and 150 days spent in the hospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room visits. Our study supports the concept that the use of intermittent inotropic therapy in the outpatient setting plays an important role in managing this severely ill group of patients.