Continuous Inotrope Therapy in Hospice Care: A Case Series.
end-of-life
heart failure
hospice
inotrope
palliative
transitions of care
Journal
The American journal of hospice & palliative care
ISSN: 1938-2715
Titre abrégé: Am J Hosp Palliat Care
Pays: United States
ID NLM: 9008229
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
pubmed:
12
1
2019
medline:
18
12
2019
entrez:
12
1
2019
Statut:
ppublish
Résumé
Continuous cardiac inotropes are increasingly utilized for symptom management in advanced heart failure (AHF). Among patients who are not eligible for cardiac transplant or mechanical circulatory support, many are hospice eligible at the time of inotrope initiation. Nevertheless, given relative infrequent use as well as cost issues, acceptability and management of inotropes in the hospice setting are likely widely variable between hospice agencies. To describe hospice care experiences for patients with AHF receiving continuous inotrope therapies and weaning inotropes at the end of life. Single-institution retrospective chart review of patients with AHF receiving continuous inotropes who were discharged from the hospital to hospice care between February 2015 and October 2016 and survey of hospice medical directors providing direct care of these patients. Eighteen patients with AHF receiving continuous inotropes were discharged to 6 hospice agencies. Twelve patients were weaned from inotropes prior to death. Among cases where the inotrope was weaned, patients lived several days to more than 2 weeks. All hospice medical directors surveyed would accept patients on inotropes again. Most believed that providing continuous inotrope therapy for patients with AHF is compatible with the philosophy of hospice care. Cardiac inotropes can align with both the goals of care for the patient with AHF and the philosophy of hospice care. Patients with AHF admitted to hospice care on continuous inotropes may live days to weeks, whether or not inotropes are discontinued.
Sections du résumé
BACKGROUND
BACKGROUND
Continuous cardiac inotropes are increasingly utilized for symptom management in advanced heart failure (AHF). Among patients who are not eligible for cardiac transplant or mechanical circulatory support, many are hospice eligible at the time of inotrope initiation. Nevertheless, given relative infrequent use as well as cost issues, acceptability and management of inotropes in the hospice setting are likely widely variable between hospice agencies.
OBJECTIVE
OBJECTIVE
To describe hospice care experiences for patients with AHF receiving continuous inotrope therapies and weaning inotropes at the end of life.
DESIGN
METHODS
Single-institution retrospective chart review of patients with AHF receiving continuous inotropes who were discharged from the hospital to hospice care between February 2015 and October 2016 and survey of hospice medical directors providing direct care of these patients.
RESULTS
RESULTS
Eighteen patients with AHF receiving continuous inotropes were discharged to 6 hospice agencies. Twelve patients were weaned from inotropes prior to death. Among cases where the inotrope was weaned, patients lived several days to more than 2 weeks. All hospice medical directors surveyed would accept patients on inotropes again. Most believed that providing continuous inotrope therapy for patients with AHF is compatible with the philosophy of hospice care.
CONCLUSION
CONCLUSIONS
Cardiac inotropes can align with both the goals of care for the patient with AHF and the philosophy of hospice care. Patients with AHF admitted to hospice care on continuous inotropes may live days to weeks, whether or not inotropes are discontinued.
Identifiants
pubmed: 30630349
doi: 10.1177/1049909118823187
doi:
Substances chimiques
Cardiotonic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM