• J Pain Symptom Manage · Jan 2018

    Review

    Continuous cardiac inotropes in patients with end-stage heart failure: an evolving experience.

    • Kasey Malotte, Agafe Saguros, and Hunter Groninger.
    • Cedars Sinai Medical Center, Los Angeles, California, USA; MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
    • J Pain Symptom Manage. 2018 Jan 1; 55 (1): 159-163.

    AbstractHeart failure (HF) experts recommend initiation of continuous inotrope therapy, such as milrinone or dobutamine, for clinically decompensating patients with stage D HF. Although originally intended to serve solely as a bridge to more definitive surgical therapies, more and more patients are receiving inotrope therapy for purely palliative purposes. In these cases, questions arise regarding care at the end of life. What criteria determine ongoing clinical benefit? Should the inotrope be continued until death? Should inotrope dosing be increased within recommended guidelines to improve symptoms? What is the role of inotropes in hospice care? Here, we describe such a case as a springboard to contemplate the evolving role of inotrope therapies and how hospice and palliative providers may interface with this rapidly developing face of advanced HF care.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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