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

Kishore J. Harjai, M. R. Mehra, H. O. Ventura, Y. M. Lapeyre, L. E. Manchester, V. E. Zeringue, D. D. Stapleton, Joseph P Murgo, F. W. Smart

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalChest
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1996
Externally publishedYes

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Heart Failure
Costs and Cost Analysis
Length of Stay
Therapeutics
Milrinone
Dobutamine
Cost Control
Cost Savings
Home Care Services
Ambulatory Care
Health Care Costs
Stroke Volume
Hospitalization
Economics
Population

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Harjai, K. J., Mehra, M. R., Ventura, H. O., Lapeyre, Y. M., Manchester, L. E., Zeringue, V. E., ... Smart, F. W. (1996). Home intravenous inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes. Chest, 110(4 SUPPL.).

Home intravenous inotropic therapy in advanced heart failure : Cost analysis and clinical outcomes. / Harjai, Kishore J.; Mehra, M. R.; Ventura, H. O.; Lapeyre, Y. M.; Manchester, L. E.; Zeringue, V. E.; Stapleton, D. D.; Murgo, Joseph P; Smart, F. W.

In: Chest, Vol. 110, No. 4 SUPPL., 10.1996.

Research output: Contribution to journalArticle

Harjai, KJ, Mehra, MR, Ventura, HO, Lapeyre, YM, Manchester, LE, Zeringue, VE, Stapleton, DD, Murgo, JP & Smart, FW 1996, 'Home intravenous inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes', Chest, vol. 110, no. 4 SUPPL..
Harjai KJ, Mehra MR, Ventura HO, Lapeyre YM, Manchester LE, Zeringue VE et al. Home intravenous inotropic therapy in advanced heart failure: Cost analysis and clinical outcomes. Chest. 1996 Oct;110(4 SUPPL.).
Harjai, Kishore J. ; Mehra, M. R. ; Ventura, H. O. ; Lapeyre, Y. M. ; Manchester, L. E. ; Zeringue, V. E. ; Stapleton, D. D. ; Murgo, Joseph P ; Smart, F. W. / Home intravenous inotropic therapy in advanced heart failure : Cost analysis and clinical outcomes. In: Chest. 1996 ; Vol. 110, No. 4 SUPPL.
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abstract = "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.",
author = "Harjai, {Kishore J.} and Mehra, {M. R.} and Ventura, {H. O.} and Lapeyre, {Y. M.} and Manchester, {L. E.} and Zeringue, {V. E.} and Stapleton, {D. D.} and Murgo, {Joseph P} and Smart, {F. W.}",
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T2 - Cost analysis and clinical outcomes

AU - Harjai, Kishore J.

AU - Mehra, M. R.

AU - Ventura, H. O.

AU - Lapeyre, Y. M.

AU - Manchester, L. E.

AU - Zeringue, V. E.

AU - Stapleton, D. D.

AU - Murgo, Joseph P

AU - Smart, F. W.

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N2 - 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.

AB - 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.

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