Palliative Continuous IV Inotropic Support Is Uncommon

Background: Palliative care is very helpful among many seriously ill patients growing close to end-of-life. Patients with stage D heart failure (HF) may have a 1-year survival rate of 25%. Continuous IV inotropic support (CIIS) is often used among these patients as a bridge to mechanical circulatory support or heart transplantation, but many of these patients are not candidates for these interventions. Guidelines from the American Heart Association/American College of Cardiology/Heart Failure Society of America suggest CIIS among these patients to reduce distressing symptomatology and improve functional status, but this is a class IIb recommendation with a limited evidence base. Published literature suggests no evidence of a survival benefit with CIIS; therefore, this is considered a purely palliative intervention. Objective: To study the use and outcomes of palliative CIIS in patients with stage D HF. Design: Retrospective cohort study. Participants/Methods: 1,463,942 Medicare fee-f more...