Dobutamine therapy at home under the guidance of a nurse practitioner, either as a bridge to cardiac transplantation or as destination therapy in severe heart failure

OBJECTIVE: To evaluate the results of intravenous dobutamine therapy at home for ambulatory patients with severe heart failure.DESIGN: Retrospective.METHOD: Data were retrieved for the 40 patients that had been treated with intravenous dobutamine at home during the period from 1 January 1994 until mid-November 2006 at the Thorax Centre of Groningen University Medical Centre, The Netherlands. The patients were guided by a nurse practitioner.RESULTS: The study group comprised 31 men and 9 women. The 22 patients on the waiting list for a heart transplant had an average age of 49 years. For the other 18 patients, on average 63 years old, it was destination therapy. The mean administered dosage ofdobutamine was 4 microg/kg/ min (range: 2-10). Pre-transplantation and destination therapy were given for an average of 3.5 and 1.5 months, respectively. A successful transplantation was performed in 14 (64%) of the 22 waiting-list candidates; 2 patients were still on the waiting list and 6 died while on the waiting list. Intravenous access complications and ICD shocks each occurred in 6 (15%) patients. The quality of life was reasonable to fair in the waiting-list patients and moderate to reasonable in those given destination therapy. The costs for medication and hire of the infusion pump were Euro 450 per month.CONCLUSION: Dobutamine infusion therapy at home under the guidance of a nurse practitioner, either as a bridge to cardiac transplantation or as destination therapy in patients with severe heart failure, appeared safe, feasible and not expensive.