Non-invasive Venous Waveform Analysis (niva) Correlates With Pulmonary Capillary Wedge Pressure And Predicts 30-day Admission In Heart Failure Patients Undergoing Right Heart Catheterization
HFSA ePoster Library. Alvis B. 09/11/21; 343484; 25
Bret Alvis
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Abstract
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Introduction: Despite medical optimization, patients with advanced heart failure (AHF) develop refractory symptoms, resulting in frequent hospitalizations and functional limitations. For those who do not receive advanced therapies, the focus shifts to palliation. Previous trials of inotrope use demonstrated improved hemodynamics and functional class, albeit with a concern for increased mortality. These studies preceded modern care standards. Data regarding inotrope choice and utility as palliative therapy is limited.
Hypothesis: Patients with AHF discharged on continuous, intravenous milrinone for palliative intent reduces the incidence of rehospitalization compared to dobutamine.
Methods: This single-center, retrospective cohort study included patients 18-89 years old with AHF, reduced left-ventricular ejection fraction (LVEF<40%) and discharged between January 2015 and April 2020 on continuous intravenous dobutamine or milrinone for palliation. Exclusion criteria include inotrope as bridge to transplant or mechanical circulatory support (MCS), or pre-existing MCS. The primary outcome was incidence of all-cause rehospitalization compared by treatment type. Secondary outcomes include survival, time to either rehospitalization or death, and days alive and out of the hospital. Treatment arms were compared using chi-square and Wilcoxon rank-sum tests. Log-rank tests were used for time-to-event outcomes.
Results: Of 222 patients included, 135 were in the dobutamine and 87 in the milrinone arm. Demographics between groups were similar. Mean LVEF was 17.5%. In the milrinone arm, age and B-type natriuretic peptide were lower; more patients were discharged on beta blockers (22.2% vs 62.1%; p<0.001). Compared to dobutamine, more patients in the milrinone arm were rehospitalized within 180 days of discharge (58.9% vs 79.5%; p=0.002). Mortality was lower in the milrinone arm (80% vs 63.2%; p=0.006) and overall survival was longer (median: 52 vs 228 days; p<0.001). Time to either rehospitalization or death was longer in the milrinone group (16 vs 29 days; p=0.048); these patients spent more days alive and out of the hospital at 90 days post-discharge (37 vs 70 days; p<0.001).
Conclusion: In a real-world population, our study found potential benefit associated with milrinone utilization in regard to the primary and secondary outcomes; this will be further explored with multivariable analysis. More trial data is needed to validate mortality and quality of life outcomes.
Hypothesis: Patients with AHF discharged on continuous, intravenous milrinone for palliative intent reduces the incidence of rehospitalization compared to dobutamine.
Methods: This single-center, retrospective cohort study included patients 18-89 years old with AHF, reduced left-ventricular ejection fraction (LVEF<40%) and discharged between January 2015 and April 2020 on continuous intravenous dobutamine or milrinone for palliation. Exclusion criteria include inotrope as bridge to transplant or mechanical circulatory support (MCS), or pre-existing MCS. The primary outcome was incidence of all-cause rehospitalization compared by treatment type. Secondary outcomes include survival, time to either rehospitalization or death, and days alive and out of the hospital. Treatment arms were compared using chi-square and Wilcoxon rank-sum tests. Log-rank tests were used for time-to-event outcomes.
Results: Of 222 patients included, 135 were in the dobutamine and 87 in the milrinone arm. Demographics between groups were similar. Mean LVEF was 17.5%. In the milrinone arm, age and B-type natriuretic peptide were lower; more patients were discharged on beta blockers (22.2% vs 62.1%; p<0.001). Compared to dobutamine, more patients in the milrinone arm were rehospitalized within 180 days of discharge (58.9% vs 79.5%; p=0.002). Mortality was lower in the milrinone arm (80% vs 63.2%; p=0.006) and overall survival was longer (median: 52 vs 228 days; p<0.001). Time to either rehospitalization or death was longer in the milrinone group (16 vs 29 days; p=0.048); these patients spent more days alive and out of the hospital at 90 days post-discharge (37 vs 70 days; p<0.001).
Conclusion: In a real-world population, our study found potential benefit associated with milrinone utilization in regard to the primary and secondary outcomes; this will be further explored with multivariable analysis. More trial data is needed to validate mortality and quality of life outcomes.
Introduction: Despite medical optimization, patients with advanced heart failure (AHF) develop refractory symptoms, resulting in frequent hospitalizations and functional limitations. For those who do not receive advanced therapies, the focus shifts to palliation. Previous trials of inotrope use demonstrated improved hemodynamics and functional class, albeit with a concern for increased mortality. These studies preceded modern care standards. Data regarding inotrope choice and utility as palliative therapy is limited.
Hypothesis: Patients with AHF discharged on continuous, intravenous milrinone for palliative intent reduces the incidence of rehospitalization compared to dobutamine.
Methods: This single-center, retrospective cohort study included patients 18-89 years old with AHF, reduced left-ventricular ejection fraction (LVEF<40%) and discharged between January 2015 and April 2020 on continuous intravenous dobutamine or milrinone for palliation. Exclusion criteria include inotrope as bridge to transplant or mechanical circulatory support (MCS), or pre-existing MCS. The primary outcome was incidence of all-cause rehospitalization compared by treatment type. Secondary outcomes include survival, time to either rehospitalization or death, and days alive and out of the hospital. Treatment arms were compared using chi-square and Wilcoxon rank-sum tests. Log-rank tests were used for time-to-event outcomes.
Results: Of 222 patients included, 135 were in the dobutamine and 87 in the milrinone arm. Demographics between groups were similar. Mean LVEF was 17.5%. In the milrinone arm, age and B-type natriuretic peptide were lower; more patients were discharged on beta blockers (22.2% vs 62.1%; p<0.001). Compared to dobutamine, more patients in the milrinone arm were rehospitalized within 180 days of discharge (58.9% vs 79.5%; p=0.002). Mortality was lower in the milrinone arm (80% vs 63.2%; p=0.006) and overall survival was longer (median: 52 vs 228 days; p<0.001). Time to either rehospitalization or death was longer in the milrinone group (16 vs 29 days; p=0.048); these patients spent more days alive and out of the hospital at 90 days post-discharge (37 vs 70 days; p<0.001).
Conclusion: In a real-world population, our study found potential benefit associated with milrinone utilization in regard to the primary and secondary outcomes; this will be further explored with multivariable analysis. More trial data is needed to validate mortality and quality of life outcomes.
Hypothesis: Patients with AHF discharged on continuous, intravenous milrinone for palliative intent reduces the incidence of rehospitalization compared to dobutamine.
Methods: This single-center, retrospective cohort study included patients 18-89 years old with AHF, reduced left-ventricular ejection fraction (LVEF<40%) and discharged between January 2015 and April 2020 on continuous intravenous dobutamine or milrinone for palliation. Exclusion criteria include inotrope as bridge to transplant or mechanical circulatory support (MCS), or pre-existing MCS. The primary outcome was incidence of all-cause rehospitalization compared by treatment type. Secondary outcomes include survival, time to either rehospitalization or death, and days alive and out of the hospital. Treatment arms were compared using chi-square and Wilcoxon rank-sum tests. Log-rank tests were used for time-to-event outcomes.
Results: Of 222 patients included, 135 were in the dobutamine and 87 in the milrinone arm. Demographics between groups were similar. Mean LVEF was 17.5%. In the milrinone arm, age and B-type natriuretic peptide were lower; more patients were discharged on beta blockers (22.2% vs 62.1%; p<0.001). Compared to dobutamine, more patients in the milrinone arm were rehospitalized within 180 days of discharge (58.9% vs 79.5%; p=0.002). Mortality was lower in the milrinone arm (80% vs 63.2%; p=0.006) and overall survival was longer (median: 52 vs 228 days; p<0.001). Time to either rehospitalization or death was longer in the milrinone group (16 vs 29 days; p=0.048); these patients spent more days alive and out of the hospital at 90 days post-discharge (37 vs 70 days; p<0.001).
Conclusion: In a real-world population, our study found potential benefit associated with milrinone utilization in regard to the primary and secondary outcomes; this will be further explored with multivariable analysis. More trial data is needed to validate mortality and quality of life outcomes.
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