Home inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes

Kishore J. Harjai, Mandeep R. Mehra, Hector O. Ventura, Yvette M. Lapeyre, Joseph P Murgo, Dwight D. Stapleton, Frank W. Smart

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Study objectives: This study was conducted to assess east savings and clinical outcomes associated with the use of home IV inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure. Design: Retrospective analysis. Setting: Tertiary care referral center. Patients and interventions: Twenty-four patients (13 men, 11 women; age, 61 ± 12 years) with left ventricular ejection fraction<30% and heart failure refractory to oral agents required home IV inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0±2.2 μg/kg/min) or milrinone (n=7; dose, 0.53±0.05 μg/kg/min). Measurements and results: Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9±2.7 months) was associated with a 16% reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7±2.6 to 1.3±1.3 (p=0.056) and length of hospital stay from 20.9±12.7 to 5.5±5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0±0.0 to 2.7±0.9 (p<0.0001). Eight patients (38%) died after 2.8± 1.7 months of home IV inotropic therapy. Conclusions: Home IV inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.

Original languageEnglish (US)
Pages (from-to)1298-1303
Number of pages6
JournalChest
Volume112
Issue number5
StatePublished - 1997
Externally publishedYes

Fingerprint

Heart Failure
Costs and Cost Analysis
Length of Stay
Tertiary Care Centers
Therapeutics
Milrinone
Dobutamine
Stroke Volume

Keywords

  • Clinical outcomes
  • Heart failure
  • Inotropic agents

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Harjai, K. J., Mehra, M. R., Ventura, H. O., Lapeyre, Y. M., Murgo, J. P., Stapleton, D. D., & Smart, F. W. (1997). Home inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes. Chest, 112(5), 1298-1303.

Home inotropic therapy in advanced heart failure : Cost analysis and clinical outcomes. / Harjai, Kishore J.; Mehra, Mandeep R.; Ventura, Hector O.; Lapeyre, Yvette M.; Murgo, Joseph P; Stapleton, Dwight D.; Smart, Frank W.

In: Chest, Vol. 112, No. 5, 1997, p. 1298-1303.

Research output: Contribution to journalArticle

Harjai, KJ, Mehra, MR, Ventura, HO, Lapeyre, YM, Murgo, JP, Stapleton, DD & Smart, FW 1997, 'Home inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes', Chest, vol. 112, no. 5, pp. 1298-1303.
Harjai KJ, Mehra MR, Ventura HO, Lapeyre YM, Murgo JP, Stapleton DD et al. Home inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes. Chest. 1997;112(5):1298-1303.
Harjai, Kishore J. ; Mehra, Mandeep R. ; Ventura, Hector O. ; Lapeyre, Yvette M. ; Murgo, Joseph P ; Stapleton, Dwight D. ; Smart, Frank W. / Home inotropic therapy in advanced heart failure : Cost analysis and clinical outcomes. In: Chest. 1997 ; Vol. 112, No. 5. pp. 1298-1303.
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abstract = "Study objectives: This study was conducted to assess east savings and clinical outcomes associated with the use of home IV inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure. Design: Retrospective analysis. Setting: Tertiary care referral center. Patients and interventions: Twenty-four patients (13 men, 11 women; age, 61 ± 12 years) with left ventricular ejection fraction<30{\%} and heart failure refractory to oral agents required home IV inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0±2.2 μg/kg/min) or milrinone (n=7; dose, 0.53±0.05 μg/kg/min). Measurements and results: Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9±2.7 months) was associated with a 16{\%} reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7±2.6 to 1.3±1.3 (p=0.056) and length of hospital stay from 20.9±12.7 to 5.5±5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0±0.0 to 2.7±0.9 (p<0.0001). Eight patients (38{\%}) died after 2.8± 1.7 months of home IV inotropic therapy. Conclusions: Home IV inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.",
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