PMID- 9367472
OWN - NLM
STAT- MEDLINE
DCOM- 19971201
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 112
IP  - 5
DP  - 1997 Nov 5
TI  - Home inotropic therapy in advanced heart failure: cost analysis and clinical 
      outcomes.
PG  - 1298-303
AB  - STUDY OBJECTIVES: This study was conducted to assess cost savings and clinical 
      outcomes associated with the use of home i.v. 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 i.v. 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 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 
      microg/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 i.v. inotropic therapy. CONCLUSIONS: Home 
      i.v. 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.
FAU - Harjai, K J
AU  - Harjai KJ
AD  - Department of Medicine, Ochsner Medical Institutions, New Orleans, LA 70121, USA.
FAU - Mehra, M R
AU  - Mehra MR
FAU - Ventura, H O
AU  - Ventura HO
FAU - Lapeyre, Y M
AU  - Lapeyre YM
FAU - Murgo, J P
AU  - Murgo JP
FAU - Stapleton, D D
AU  - Stapleton DD
FAU - Smart, F W
AU  - Smart FW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Pyridones)
RN  - 3S12J47372 (Dobutamine)
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Cardiotonic Agents/*economics/therapeutic use
MH  - Cause of Death
MH  - Costs and Cost Analysis
MH  - *Direct Service Costs
MH  - Dobutamine/*economics/therapeutic use
MH  - Female
MH  - Heart Failure/drug therapy/*economics/mortality
MH  - Home Care Services/*economics
MH  - Humans
MH  - Length of Stay/economics
MH  - Male
MH  - Middle Aged
MH  - Milrinone
MH  - Pyridones/*economics/therapeutic use
MH  - Retrospective Studies
MH  - Stroke Volume/drug effects
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 1997/11/21 00:00
MHDA- 1997/11/21 00:01
CRDT- 1997/11/21 00:00
PHST- 1997/11/21 00:00 [pubmed]
PHST- 1997/11/21 00:01 [medline]
PHST- 1997/11/21 00:00 [entrez]
AID - S0012-3692(15)47315-5 [pii]
AID - 10.1378/chest.112.5.1298 [doi]
PST - ppublish
SO  - Chest. 1997 Nov 5;112(5):1298-303. doi: 10.1378/chest.112.5.1298.