Chronic inotropic therapy in end-stage heart failure
Chronic inotropic therapy in end-stage heart failure
复制标题
DOI：
10.1016/j.ahj.2006.08.003
复制
发表时间：
2006-12-01
影响因子：
4.8
通讯作者：
Schnitzler, Mark A.
中科院分区：
文献类型：
--
作者：
Hauptman, Paul J.;Mikolajczak, Peter;Schnitzler, Mark A.
背景 对晚期心力衰竭提供症状缓解和减少再入院的干预措施非常重要。慢性静脉正性肌力治疗代表了一种被提倡用于姑息治疗的药理学方法。然而，人们对相关的死亡率和费用知之甚少。因此，我们试图描述慢性输注对资源利用和生存的影响。方法回顾了 17 个州医疗保险地区 1995 年至 2002 年的数据。我们获得了慢性输注开始前后 180 天累计的医院和门诊支出。医疗保健使用的定义是每位受益人报销的药物和住院费用。根据风险天数生成药物报销美元和住院费用的平均累积成本曲线。 结果 该队列的平均年龄 (n = 331) 为 69.1 +/- 11.3 岁。 6 个月时死亡率超过 40%。在所有时间点都观察到住院天数的减少。开始正性肌力药物治疗之前和之后 30 天和 60 天报销的金额；然而，在六个月时，由于米力农的成本，报销的金额更高。 结论 长期静脉注射正性肌力药物与高死亡率相关。米力农的费用很高，但随后的住院费用却有所减少。在缺乏适当设计的临床试验的情况下，数据表明，使用正性肌力药物的决定、正性肌力药物的选择以及治疗持续时间应反映对资源利用的影响。
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.