부산대학교 도서관

Introduction:Home intravenous (IV) milrinone has been recommended as a bridge to decision or as palliative therapy in patients with advanced heart failure (HF). Initial studies showed improved HF symptoms and decreased hospital readmission but increased mortality rate. A previous study showed a 1-year survival rate of 47.6%. However, most studies were conducted before the widespread use of today?s advanced treatment strategies. Our study aims to investigate the contemporary outcomes of home milrinone therapy.Methods:We conducted a retrospective study in adult patients who were placed on continuous home milrinone infusion therapy and followed at the outpatient CHF clinic at Texas Tech Cardiovascular Clinic, Lubbock, from July 31st, 2015 to August 1st, 2018.Results:Fifty patients were included in the study with a mean age of 57 ? 14, 88% were male. Diabetes mellitus, chronic kidney disease (stage III disease and above) and ischemic cardiomyopathy were present in 21(42%), 20(40%) and 23(46%) patients respectively. Average left ventricular ejection fraction was 17 ? 8.7%. At baseline, 22 patients (44%) were at functional class III and the rest were at class IV. At one-year post initiation of milrinone therapy, the number of patients with functional class II, III and IV were 11(22%), 17(34%) and 22(44%) patients respectively. The number of patients hospitalized due to heart failure after starting milrinone compared to one year prior showed a significant decrease from 36(72%) to 22(44%) (p<0.05; CI 8.7%-44.6%) The number of patients that developed ventricular tachycardia and significant hypotension were 8 and 6 patients, respectively. Six patients developed infection related to home IV infusion (access site infection in 3 patients, bacteremia in 2 patients and septic shock in 1 patient). The mortality rate at one year was 16%. Decompensated HF, sepsis and ventricular tachycardia accounted for 4, 2, and 2 patient deaths respectively.Conclusions:Home IV milrinone seemed to improve functional classification and decreased hospitalization due to HF. The mortality rate in our study was lower than in the previous study. Home IV milrinone is a viable option for patients with advanced HF. Prospective studies are needed to further elucidate the outcomes.