Chronic inotropic therapy in end-stage heart failure
| Autor: | Anil George, Jason Swindle, Peter Mikolajczak, Paul J. Hauptman, Robert Hoover, Mark A. Schnitzler, Clinton J. Mohr |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
Inotrope
Male medicine.medical_specialty Cardiotonic Agents Time Factors Medicare Severity of Illness Index Article Drug Administration Schedule Drug Costs Pharmacotherapy Dobutamine Severity of illness Medicine Humans Intensive care medicine Infusions Intravenous Aged Heart Failure business.industry Length of Stay Middle Aged medicine.disease Clinical trial Heart failure Cohort Milrinone Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Popis: | Background Interventions in advanced heart failure that provide symptom relief and decrease hospital readmission are important. Chronic intravenous inotropic therapy represents a pharmacologic approach that has been advocated for palliative treatment. However, little is known about associated mortality and cost. Therefore, we sought to describe the impact of chronic infusions on resource use and survival. Methods Data were reviewed for a 17-state Medicare region from 1995 to 2002. We obtained hospital and outpatient expenditures accrued up to 180 days before and after the initiation of chronic infusions. Health care use was defined by dollars reimbursed for drug and hospitalizations per beneficiary. Average accumulated cost curves were generated for dollars reimbursed for drug and for hospitalizations by days at risk. Results The mean age of the cohort (n = 331) was 69.1 ± 11.3 years. Mortality exceeded 40% at 6 months. Reductions in hospital days were observed at all time points. The amounts reimbursed at 30 and 60 days before and after initiation of inotrope favor drug therapy; however, at six months, the amounts reimbursed were greater due to the cost of milrinone. Conclusions Chronic intravenous inotrope use was associated with a high mortality. The cost for milrinone was significant, but there was a decrease in expenditures for subsequent hospitalizations. In the absence of appropriately designed clinical trials, the data suggest that the decision to use inotropes, the choice of inotrope, and the duration of treatment should reflect the impact on resource use. |
| Databáze: | OpenAIRE |
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