Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy
BackgroundMany patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compar...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.918146/full |
| _version_ | 1811282839308599296 |
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| author | Anirudh Rao Anirudh Rao Manavotam Singh Mansi Maini Kelley M. Anderson Nancy A. Crowell Paul R. Henderson Sherry S. Gholami Farooq H. Sheikh Farooq H. Sheikh Samer S. Najjar Hunter Groninger Hunter Groninger |
| author_facet | Anirudh Rao Anirudh Rao Manavotam Singh Mansi Maini Kelley M. Anderson Nancy A. Crowell Paul R. Henderson Sherry S. Gholami Farooq H. Sheikh Farooq H. Sheikh Samer S. Najjar Hunter Groninger Hunter Groninger |
| author_sort | Anirudh Rao |
| collection | DOAJ |
| description | BackgroundMany patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.MethodsSingle-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.ResultsOf 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001).ConclusionPatients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy. |
| first_indexed | 2024-04-13T01:59:45Z |
| format | Article |
| id | doaj.art-b7a189f9e82c4eeab486c9a4bd5990fb |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T01:59:45Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b7a189f9e82c4eeab486c9a4bd5990fb2022-12-22T03:07:39ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-08-01910.3389/fcvm.2022.918146918146Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapyAnirudh Rao0Anirudh Rao1Manavotam Singh2Mansi Maini3Kelley M. Anderson4Nancy A. Crowell5Paul R. Henderson6Sherry S. Gholami7Farooq H. Sheikh8Farooq H. Sheikh9Samer S. Najjar10Hunter Groninger11Hunter Groninger12Department of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesSection of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United StatesMedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United StatesDepartment of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesGeorgetown University School of Nursing and Health Studies, Washington, DC, United StatesGeorgetown University School of Nursing and Health Studies, Washington, DC, United StatesDepartment of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesDepartment of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesDepartment of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesMedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United StatesMedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United StatesDepartment of Medicine, Georgetown University School of Medicine, Washington, DC, United StatesSection of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United StatesBackgroundMany patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.MethodsSingle-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.ResultsOf 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001).ConclusionPatients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy.https://www.frontiersin.org/articles/10.3389/fcvm.2022.918146/fullinotropesStage D heart failurepalliative careLVADheart transplant |
| spellingShingle | Anirudh Rao Anirudh Rao Manavotam Singh Mansi Maini Kelley M. Anderson Nancy A. Crowell Paul R. Henderson Sherry S. Gholami Farooq H. Sheikh Farooq H. Sheikh Samer S. Najjar Hunter Groninger Hunter Groninger Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy Frontiers in Cardiovascular Medicine inotropes Stage D heart failure palliative care LVAD heart transplant |
| title | Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| title_full | Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| title_fullStr | Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| title_full_unstemmed | Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| title_short | Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| title_sort | bridge to nowhere a retrospective single center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy |
| topic | inotropes Stage D heart failure palliative care LVAD heart transplant |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.918146/full |
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