New Study of Option Care Data Suggests Improved Survival for Heart Failure Patients Receiving Home Infusion of Inotropic Therapy When Coupled with Guideline-Directed Medical Therapy

BANNOCKBURN, Ill.–(BUSINESS WIRE)–#OptionCare–Survival may improve when advanced heart failure patients receiving home
infusion of inotropic therapy are also receiving guideline-directed
care, suggest results of a large study recently published in The
Journal of Heart and Lung Transplantation
.1 The study was
conducted by investigators from Keck
School of Medicine of USC
and Option
Care Enterprises, Inc.
, the nation’s largest independent provider of
home and alternate treatment site infusion services.

Patients with advanced heart failure (Stage D) may be prescribed
intravenous (IV) inotropic therapy while they await a heart transplant
or mechanical circulatory support, or as a palliative measure. The
therapy may improve quality of life2 by enabling patients’
hearts to pump more efficiently, which may increase their energy levels
and may help them breathe easier. While previous research found that
patients receiving inotropic therapy survived an average of three to six
months, the study of Option Care data suggests an average survival of
more than two years.3,4 Additionally, survival is improved
when doctors follow American College of Cardiology Foundation/American
Heart Association (ACCF/AHA) guideline recommendations for delivering
the therapy, which includes prescribing other medications such as beta
blockers.

“Advanced heart failure patients suffer from extreme fatigue and poor
quality of life. Inotropic therapy can make a big difference in their
lives, helping them get back to the day-to-day activities that many of
us take for granted, such as enjoying time with family,” said Luanda
P. Grazette, MD, MPH
, principal investigator of the study and
associate professor of clinical medicine at the Keck School of Medicine
of USC. “As doctors, we sometimes avoid inotropic therapy out of
concerns about decreasing survival. Through this research we found that
survival on inotropes has improved quite a bit compared to what was
observed from studies in the late 1990s and early 2000s. In this study
it was not unusual for many patients to live for years on this therapy.
This was quite a surprise.”

“Receiving this life-changing therapy in the comfort of home helps
patients more fully enjoy their lives,” said Tess Artig-Brown, BSN, MN,
co-author of the study and director of Option Care’s Heart Failure
Program. “Patients are able to spend more time at home surrounded by
family rather than in a hospital or long-term care center where they may
be exposed to antibiotic-resistant infections. Home infusion is also
much more cost effective than care provided in the hospital or long-term
care centers and research has shown that with education and support,
these patients are less likely to be readmitted to the hospital.5

Presented recently at the 38th Annual Meeting and Scientific
Sessions of the International Society for Heart and Lung Transplantation
in Nice, France, the study is the largest to date to focus on long-term
use of inotropic therapy.

The study included 3,296 advanced heart failure patients treated with
inotropes between May 2009 and June 2016. The overall adjusted median
survival on continuous inotrope therapy was 771 days. The average time
on inotrope therapy was 171.2 days with a minimum of one day and a
maximum of 2,204 days. The majority of patients, 2,300 (69.8 percent),
were treated with milrinone, 942 (28.6 percent) with dobutamine and 54
(1.6 percent) received dopamine. Beta blocker therapy, used by 799
patients (24.2 percent), reduced mortality by 50 percent.

Earlier studies reported a higher mortality rate among patients on
inotropic therapy, but they were conducted when the treatment practices
were different, including bolusing (providing a large initial dose) –
which has since been determined to be too taxing for the heart –
followed by continuous infusion at much higher doses than what is
currently used. Most physicians now start patients on the lowest dose
and increase it slowly to achieve the desired result. The guidelines
note it’s important that prior to advancing to Stage D, heart failure
patients are prescribed oral and mechanical therapies as appropriate,
such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors or
implantable cardioverter defibrillators (ICDs).

About Option Care

Option Care Enterprises, Inc. (Option Care) is the nation’s largest and
most trusted provider of home and alternate treatment site infusion
services. An industry leader, the company draws on nearly 40 years of
clinical care experience to offer patient-centered therapy management.
Option Care’s signature Home Infusion Plus services include the clinical
management of infusion medicines, nursing support and care coordination.
Option Care’s multidisciplinary team of more than 1,800 clinicians –
including pharmacists, nurses and dietitians – are able to provide home
infusion service coverage for nearly all patients across the United
States needing treatment for complex and chronic conditions. Learn more
at www.OptionCare.com.

  1. Havakuk O, Tran J, Artig-Brown T, et al. Intravenous inotropes, beta
    blockers and survival in ambulatory heart failure patients – a
    contemporary study in 3,311 patients. J Heart Lung Transplant.
    2018;37(4)(suppl):S202.
  2. Walther K, Artig-Brown T, et al. The impact of home infusion on
    quality of life in patients with heart failure receiving home
    inotropic therapy based on the Minnesota Living With Heart Failure
    Questionnaire. Poster presented at the 2017 National Home Infusion
    Association (NHIA) Annual Conference & Exposition: May 22-25, 2017;
    Orlando, Fla.
  3. Hauptman PJ, Mikolajczak P, George A, Mohr et al. Chronic inotropic
    therapy in end-stage heart failure. Am Heart J. 2006;152:1096
    e1-8.
  4. Hershberger RE, Nauman D, Walker TL, et al. Care processes and
    clinical outcomes of continuous outpatient support with inotropes
    (COSI) in patients with refractory endstage heart failure. J Card
    Fail.
    2003;9:180-7.
  5. Meaux N. and Tatiel M. Hospital admission reductions among Stage D
    heart failure patients participating in a home inotropic infusion
    program. Poster presented at 7th Annual Meeting of the
    American Association of Heart Failure Nurses (AAHFN): June 23-25,
    2011; Seattle.

Contacts

For Option Care
Media Contact Information:
Kary Moyer
312-558-1770
KMoyer@pcipr.com