BANNOCKBURN, Ill., May 16, 2018 — 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.[*]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.  The study was conducted by investigators from Keck School of Medicine of USC and Option Care Health, 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 life[*]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. 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.[*]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. [*]Hershberger RE, Nauman D, Walker TL, et al. Care processes and clinical outcomes of continuous outpatient support with inotropes (COSI) in patients with refractory end-stage heart failure. J Card Fail. 2003;9:180-7. 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.”[*]Meaux N. and Tatiel M. Hospital admission reductions among Stage D heart failure patients participating in a home inotropic infusion program. Poster presented at 7^th Annual Meeting of the American Association of Heart Failure Nurses (AAHFN): June 23-25, 2011; Seattle. 

Presented recently at the 38^th 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.OptionCareHealth.com.

Patients Benefitted Significantly Overall, According to Results
Presented at NHIA Meeting

BANNOCKBURN, Ill., July 12, 2017 — Advanced heart failure patients who receive home infusion of inotropic therapy benefit from improved quality of life, according to Option Care research presented at the 2017 National Home Infusion Association (NHIA) Annual Conference & Exposition.

Patients with advanced heart failure are prescribed intravenous (IV) inotropic therapy to help their hearts pump more efficiently while they await a heart transplant or mechanical circulatory support (MCS) or to help them spend their remaining days in greater comfort. Studies have shown inotropic therapy provided in the hospital or healthcare facility is effective, but there’s been limited research on home infusion of the treatment.

“Our study shows home inotropic therapy improved quality of life in advanced heart failure patients,”[*]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. said Kyle Walther, PharmD, lead author of the study and Option Care pharmacy resident. “Because inotropic therapy typically is provided long-term, it’s invaluable that patients have the opportunity to receive this vital care in the comfort of their own homes, so they can continue to spend time with their families and enjoy the best quality of life.”

The study included 88 adult heart failure patients who filled out the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before the start of inotropic infusion and three months after home infusion of the therapy.[*]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. The MLHFQ measures the effect of heart failure on quality of life by asking patients 21 questions on issues ranging from shortness of breath to medical costs. A lower score indicates heart failure has less of an effect on the patient’s quality of life. Comparing MLHFQ results at the beginning of therapy to those after three months of therapy, researchers found that overall, there was an 8.65 percent improvement in scores among all patients, which was statistically significant. The MLHFQ scores showed home infusion of inotropic therapy was especially beneficial in reducing shortness of breath (17.13 percent improvement), hospital stays (17.65 percent improvement) and medical care cost (20.78 percent improvement).

Patients in the study received one of three types of inotropic medications: milrinone, dobutamine or dopamine. The medication was infused continuously 24 hours a day through an IV inserted in the chest or arm and stored in a small bag or fanny pack, allowing patients to be mobile. The medication was delivered to the home, and a home infusion nurse visited weekly to check the patient’s vitals, blood and infusion site and ensure the equipment was working effectively. Patients had 24/7 telephone access to pharmacists and nurses if they had questions or concerns. This high-touch care allows patients to receive help quickly, without having to wait for a response from their primary care provider or make a trip to the emergency room.

Home infusion is safe, effective and often less costly than inpatient care. For example, high-touch home infusion of inotropic medication featuring consistent clinical monitoring and support significantly reduces hospital admission rates, saving more than $17,000 per patient per year, according to Option Care research.[*]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. However, an unintended consequence of the 21st Century Cures Act, passed by the U.S. Congress and signed into law in December 2016, is the creation of a gap in Medicare coverage for home infusion of inotropic therapy, effectively taking away funding for patient access to high quality home infusion.

“Medicare pays for the care involved in providing infusion of inotropic therapy, but only if it’s provided in a hospital, nursing home or other health facility,” said Tess Artig-Brown BSN, MN, co-author of the poster and director of Option Care’s Heart Failure Program. “Few patients would choose to be in a facility receiving their care when they can be in their own homes, and our research suggests home infusion of inotropic therapy allows them to do that. Hopefully this will help draw attention to the benefits of improving patient access to high-quality home infusion.”

About Option Care
Option Care Enterprises, Inc. (Option Care) is one of the nation’s largest and most trusted providers 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.

Media Contact Information:
Lauren Kotarski
312-558-1770
LKotarski@pcipr.com
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