Many patients with ACC/AHA Stage D (advanced) HF are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure (HF) on home CIIS.

We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n=373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy, and rates of involvement of palliative care.

Overall, patients received CIIS therapy for an average of 5.9 months (SD 7.3). Patients on CIIS as palliative therapy died an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery.

In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived 6.2 months, on average, with wide variation between patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality in this sub-group.