AMBULATORY HOME INOTROPES, AN APPROPRIATE AND COST EFFECTIVE METHOD OF BRIDGING TO CARDIAC TRANSPLANTATION
C.A. Wood*, M. Lovett, D. O'Shannessey, L. Dembo, J.G. O'Driscoll.
Cardiac Transplant Unit, Royal Perth Hospital, Perth, Western Australia.
Background: Inotropic therapy is frequently utilised as a method of bridging to cardiac transplantation due to its demonstrated improvement in the haemodynamic and symptomatic condition of patients.
This study examines the cost benefits and clinical outcomes in relation to: infection rates, morbidity/mortality and hospital admission in 14 patients who were managed at home on continuous inotropic therapy whilst awaiting cardiac transplantation between October 1996 and December 1998.
Methods: All patients had a right heart catheter performed and medical treatment was optimised prior to commencement of inotropes. Inotropes were then introduced and titrated whilst the patient was an inpatient. Infusions were delivered via a brachial or subclavian catheter and a paragon infuser pump. Nine patients received dobutamine, 4 received milrinone and dobutamine, 1 received dobutamine and dopamine.
Results: The total number of days on inotropic support was 510, mean duration 36 days. 25 catheters were used during the outlined period; insertion site infections accounted for 2 of the changes, febrile episodes accounted for 3 changes, 2 catheters were changed routinely after 6 weeks and the remaining 2 fell out inadvertently.
Two patients were bridged to cardiac transplantation, 4 patients were weaned and then transplanted, 2 were weaned and remain actively listed, 4 patients were weaned and remain too well for transplantation and 2 patients died whilst on inotropes. 54% (234/510) days were spent as outpatients representing a significant cost saving. Average bed day cost $690 (Metropolitan Health Service Board Annual Report 1997/1998).
Conclusion: Ambulatory home inotropes are a cost effective method of bridging patients to cardiac transplantation offering an improved quality of life for the patient, facilitating mobility and decreasing inpatient admissions.
