Program enabled more terminal HF patients to receive home therapy

Taitel M. Am J Hosp Palliat Care. 2011;doi:10.1177/1049909111418638.

Continuous infusion of inotropic medication can be safely administered at home or in hospice as part of an overall plan to provide patients with HF a better quality of life during end stages, according to results of a recent study.

Compared with the national average, nearly twice as many patients with HF receiving Walgreens inotropic infusion care were able to receive these services at home, rather than spend their final days in a hospital or other medical facility.

The study compared end-of-life experiences of 217 patients with terminal HF enrolled in the Walgreens Inotropic Infusion Program between 2007 and 2009 with those of more than 56,000 patients with HF included in the 2007 National Center for Health Statistics Vital Statistics Cooperative Program.

Results showed that patients enrolled in the Walgreens Inotropic Infusion Program were more likely to die at home (64.5%) compared with the national sample (35.9%; P<.001).

“Many cardiologists do not realize that inotropic infusion therapy at home is an option,” Nita Meaux, RN, CRNI, director of the Walgreens Inotropic Infusion Program, told Cardiology Today. “The American College of Cardiology and American Heart Association guidelines support infusion of inotropic drugs for patients with HF as a palliative care therapy. The patient needs to be on all of the right oral medications and appropriate devices, but inotropic therapy can be one last added therapy to keep the patient comfortable and at home.”

Supported by a network of infusion pharmacies, patients in the program also learned to self-administer infusion medications, operate infusion pumps and detect signs and symptoms of infections or adverse events.

Continuous inotropic infusion therapy is not curative and is associated with increased mortality rates. Therefore, it is not recommended for nonterminal patients, the researchers said.

This study has broader implications beyond the higher quality of life that patients may experience through these home-care services, Meaux said. Continuous inotropic infusion therapy can also reduce ED visits, prevent exacerbation of symptoms that require readmission to the hospital and reduce medical costs.

“Despite the existence of hospice as a Medicare benefit for nearly 2 decades, home-based palliative care remains underutilized, especially by patients with HF. The results of our study connote that continuous inotropic therapy combined with a support program can help patient with terminal HF to remain within their homes, rather than a hospital, at end of life.

“A patient-centric approach should focus on increasing and improving palliative care options to achieve patient’s final wishes. Furthermore, treatment of terminal HF, either in a hospital or home setting, is resource intensive. When designing benefit plans reimbursement strategies, policy makers should consider the ability of inotropic infusion programs to honor patients’ wishes at end of life,” Meaux and colleagues wrote. - by Casey Murphy

Disclosure: Ms. Meaux reports no relevant financial disclosures.

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