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

Purpose: The purpose of this study was to assess the clinical and economic impact of home intravenous inotropic therapy (HIIT) in advanced heart failure (HF). Methods: Sixteen patients received HIIT for at least 4 consecutive weeks between May 1994 and December 1995. The study population (9 men, 7 women) had a mean age of 60±13 years and a left ventricular ejection fraction of 0.15±0.05. Inotropic agents used included dobutamine (n=12, mean dose 4.9±2.6 μg/kg/min), milrinone (n=2, mean dose 0.53±0.05 pg/kg/min), or a combination of both (n=2). Ten patients received continuous (24h per day) infusions. Cost of care (hospitalization, outpatient, and home health costs) and clinical outcomes (hospital admissions, length of hospital stay, NYHA class) were assessed during the period of HIIT (study period) and the immediate preceding period of equal length (control period) in each patient. The mean duration of the study and control periods was 12.2±6.7 weeks. Results: A comparison of the study and control periods is shown in the table. Number of Length of Cost Period admissions stay (days) (thousand $) Control 2.1±1.3 16.1±6.2 39.7±39.3 Study 1.1±1.2* 5.4±5.4** 28.1±21.6 *p=0.01; **p=0.0001 The study period was associated with a 29% reduction in cost, amounting to a savings of $11,580 per patient or $950 per patient per week. NYHA class decreased from 4.0±0.0 in the control period to 2.7±0.9 in the study period (p<0.0001). Six patients (37.5%) died during or shortly after discontinuation of HIIT. Conclusions: HIIT reduces admissions, length of stay, and cost of care, and improves functional class in advanced HF. Clinical Implications: Home intravenous inotropic therapy is an effective treatment strategy in patients with end-stage HF. The cost savings associated with this therapy may have significant implications in this era of cost-containment.