scholarly journals Outcome Predictors and Safety of Home Dobutamine Intravenous Infusion in End Stage Heart Failure Patients

2021 ◽  
Vol 10 (12) ◽  
pp. 2571
Author(s):  
Antoine Jobbé-Duval ◽  
Thomas Bochaton ◽  
Guillaume Baudry ◽  
Eric Bonnefoy-Cudraz ◽  
Elisabeth Hugon-Vallet ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Strategies ◽  
Significant Survival ◽  
Tertiary Center ◽  
End Stage Heart Failure ◽  
One Year ◽  
End Stage ◽  
At Home

Patients in end-stage heart failure can experiment cardiogenic shock and may not be weanable from dobutamine. The fate of these patients is a challenge for doctors, patients, family, and the institution. Dobutamine use at home can be a solution. The aim of the present study was to assess the outcome, biological predictors, and safety of dobutamine use at home in dobutamine-dependent patients. All consecutive dobutamine-dependent patients discharged with continuous home intravenous dobutamine, from a single tertiary center between February 2014 and November 2019, were retrospectively analyzed. A total of 19 patients (age 65 ± 10 years) were followed for one year. At one-year, the survival rate was 32%, (6/19). Five (26%) patients had an adverse event related to the intravenous catheter. In a multivariate logistic regression analysis, the combination of a glomerular filtration rate >60 mL/min and a brain natriuretic peptide level <1000 ng/L, were highly predictive of one-year survival (HR = 10.87, IC95% (5.78–36.44), p < 0.001). Management of dobutamine-unweanable patients after cardiogenic shock may involve dobutamine at home to permit a home return. This strategy allows a significant survival and few readmissions, and, if eligible, access to surgical strategies, such as heart transplantation. Simple biological markers at discharge can identify severe patients to refer to palliative care and good responders.

Nutrition Management in Mechanical Circulatory Support

2019 ◽  
Author(s):  
Dane A Coyne ◽  
Mitali P Shah ◽  
Kris M Mogensen ◽  
John C Klick
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Nutritional Support ◽  
Mechanical Circulatory Support ◽  
Disease Process ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Number Of Patients ◽  
End Stage Heart Failure ◽  
End Stage

Heart failure is a devastating progressive disease process that is rising in incidence throughout the world. For patients with end-stage heart failure, orthotopic heart transplantation had been the only therapeutic option. Unfortunately, the number of patients requiring such therapy far exceeds the number of available organs. Recent advancements in technology have made implantable cardiac assist devices a reality. Outcomes with these devices are superior to maximal medical therapy and may serve either as a bridge to the availability of a donor organ or as “destination” therapy for the patient with end-stage heart failure. In addition, new technology can also provide temporary mechanical support for patients with acute decompensated cardiogenic shock, allowing preservation of end-organ function until more definitive long-term mechanical support can be coordinated. Patients with end-stage heart failure experience unique nutritional challenges. Mechanical circulatory support adds yet another unique dimension to the nutritional support challenges of this patient population. This review contains 2 figures, 5 tables, and 29 references. Key words: cardiogenic shock, enteral nutrition, extracorporeal membrane oxygenation, heart failure, mechanical circulatory support, nutritional support, parenteral nutrition, ventricular assist device

Biomarkers associated with poor prognosis in patients with end-stage heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
E Romuk ◽  
B Szygula Jurkiewicz
Keyword(s):  
Heart Failure ◽  
Poor Prognosis ◽  
Funding Source ◽  
Elisa Kit ◽  
Risk Of Death ◽  
End Stage Heart Failure ◽  
One Year ◽  
End Stage ◽  
Medical University

Abstract Background Despite advances in the treatment, end-stage heart failure (HF) is a disease with a severe prognosis, showing an annual mortality rate of 30 to 50%. Due to a poor prognosis in this population of patients, it is necessary to accurately stratify the risk of death, including simple and effective prognostic markers. Objective This study aimed to determine biomarkers associated with mortality in patients with end-stage HF. Material and methods The study was a prospective analysis of optimally treated patients with end-stage HF, who were hospitalised at the Cardiology Department between 2016 and 2018. At the time of enrollment to the study routine laboratory tests, cardiopulmonary exercise tests, echocardiography and right heart catheterization were performed in all patients. Human Interleukin 33 (IL-33) and IL-1 Receptor Like 1 (IL1RL1) were measured by sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit (Human Il-33 and IL1RL1 ELISA kit, SunRedBio Technology Co, Ltd, Shanghai, China). Plasma concentration of N-terminal brain natriuretic peptide (NT-proBNP) was measured using a commercially available kit (Human NTproBNP ELISA kit, Roche Diagnostics, Mannheim, Germany). The endpoint was all-cause mortality during a one-year follow-up. The Medical University of Silesia's local Institutional Review Board approved the study protocol, and all patients provided informed consent. Results The final study group consisted of 282 patients (87.6% males, median age 57.0 years). One-year mortality rate in the analysed population was 28%. In a multivariate analysis, independent risk factors of death included NT-proBNP [Hazard Ratio (HR) 1.056 (95% Confidence Interval (CI): 1.024–1.089); P&lt;0.001], sodium [HR 0.877 (95% CI: 0.815–0.944); p&lt;0.001], IL33 [HR 0.977 (95% CI: 0.965- 0.989); p&lt;0.001] and IL1RL1 [HR 1.015 (95% CI: 1.008–1.023); p&lt;0.001) serum levels. Conclusions Our study showed that lower sodium and IL-33 levels, as well as higher NT-proBNP and IL1RL1 levels are associated with an increased risk of death in patients with end-stage HF during a one-year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, Poland

scholarly journals Outcomes of temporary mechanical circulatory support in cardiogenic shock due to end-stage heart failure

2021 ◽  
pp. 175114372098870
Author(s):  
Hoong Sern Lim ◽  
Aaron Ranasinghe ◽  
David Quinn ◽  
Colin Chue ◽  
Jorge Mascaro
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Organ Dysfunction ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Number Of Patients ◽  
Significant Difference ◽  
End Stage Heart Failure ◽  
Baseline Characteristics ◽  
End Stage

Background There are few reports of mechanical circulatory support (MCS) in patients with cardiogenic shock (CS) due to end-stage heart failure (ESHF). We evaluated our institutional MCS strategy and compared the outcomes of INTERMACS 1 and 2 patients with CS due to ESHF. Methods Retrospective analysis of prospectively collected data (November 2014 to July 2019) from a single centre. ESHF was defined by a diagnosis of HF prior to presentation with CS. Other causes of CS (eg: acute myocardial infarction) were excluded. We compared the clinical course, complications and 90-day survival of patients with CS due to ESHF in INTERMACS profile 1 and 2. Results We included 60 consecutive patients with CS due to ESHF Differences in baseline characteristics were consistent with the INTERMACS profiles. The duration of MCS was similar between INTERMACS 1 and 2 patients (14 (10–33) vs 15 (7–23) days, p = 0.439). There was no significant difference in the number of patients with complications that required intervention. Compared to INTERMACS 2, INTERMACS 1 patients had more organ dysfunction on support and significant lower 90-day survival (66% vs 34%, p = 0.016). Conclusion Our temporary MCS strategy, including earlier intervention in patients with CS due to ESHF at INTERMACS 2 was associated with less organ dysfunction and better 90-day survival compared to INTERMACS 1 patients.

scholarly journals SUSTAINED BENEFIT AT ONE YEAR FOLLOW-UP FROM TRANSAPICAL LEFT VENTRICULAR ENDOCARDIAL PACING FOR END STAGE HEART FAILURE

2010 ◽  
Vol 55 (10) ◽  
pp. A16.E155 ◽  
Author(s):  
Attila Mihalcz ◽  
Imre Kassai ◽  
Csaba Foldesi ◽  
Attila Kardos ◽  
Tamas Szili-Torok
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
End Stage Heart Failure ◽  
One Year ◽  
End Stage ◽  
Endocardial Pacing
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