Interim analysis of the INTERPRET patient registry program of advanced heart failure patients treated with intravenous inotropes in the ambulatory setting
Kearns S, Thohan V, Farr M, Rich J. Interim Analysis of the INTERPRET Patient Registry Program of Advanced Heart Failure Patients Treated with Intravenous Inotropes in the Ambulatory Setting. Journal of Cardiac Failure. 2016;22(S97-S97). doi:10.1016/j.cardfail.2016.06.310.
Inotropic therapy has been associated with increased risk of arrhythmic events and reduced survival, yet inotropes continue to be prescribed for either palliative care or as a bridge to cardiac transplantation or a ventricular assist device (VAD). We conducted an interim analysis of the Inotrope, Evaluation and Research (INTERPRET) Patient Registry Program, a contemporary registry of advanced heart failure patients receiving continuous inotropic therapy in the ambulatory setting.
METHODS: This is a multi-center, prospective, observational registry study. All patients prescribed intravenous dobutamine, dopamine, or milrinone for continuous home use and who utilized the Coram CVS Specialty vendor were eligible to participate. Outcome measures included mean time of survival on inotropes, frequency and cause of hospital readmission, arrhythmia burden including ICD shocks, patient symptoms on a 10 point scale, quality of life scores using the Kansas City Cardiomyopathy-12 (KCCQ-12) questionnaire.
RESULTS: Twenty two patients have been enrolled in the study. The average age the patients was 59 yrs (range 18–83) and the majority were male (86%). Reason for inotrope use was as a bridge to transplant (25%) or VAD (25%), as palliative care (32%), or as a temporary bridge to optimizing medical therapy (18%). Six of the patients have died (2 of which were on palliative inotropes) with an average survival time of 92 days (range 33–188). Five out of 22 patients (18%) were re-hospitalized within 30 days of discharge, none due to arrhythmia. Baseline KCCQ-12 summary scores averaged 43.2 (range 0.0–82.6). Overall, patient symptoms improved during the mean follow up of 8.4 weeks, including improvements in average scores for dyspnea on exertion (5.1– > 2.8), fatigue (5.3->3.8) and pain (2.3->1.3).
CONCLUSIONS: An interim analysis of the INTERPRET Patient Registry reveals a nearly even distribution between palliative, bridge to transplant, and bridge to VAD patients. Overall, patients report an improvement in dyspnea with exertion and fatigue during the short term. Future analyses of the complete registry will be required to determine whether inotropes can successfully improve patient symptoms in the short term while minimizing the need for rehospitalization until either a successful bridge to therapy or death.