AUTHOR=Rao Anirudh , Singh Manavotam , Maini Mansi , Anderson Kelley M. , Crowell Nancy A. , Henderson Paul R. , Gholami Sherry S. , Sheikh Farooq H. , Najjar Samer S. , Groninger Hunter 

TITLE=Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.918146

DOI=10.3389/fcvm.2022.918146

ISSN=2297-055X

ABSTRACT=Background: Many patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare these patients to patients initiated on CIIS as palliative therapy. 
Methods: Single-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics. 
Results: Of 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n=28, 76%; African American n=22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n=47, 70%; African American n=47, 70%). Most frequent reasons for crossover were frailty (n=10, 27%), cardiac arrest (n=5, 13.5%), and progressive non-cardiac illnesses (n=6, 16.2%). In both bridge group and palliative groups, most patients died outside the hospital (n=28, 76% vs n=48, 72%, P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P <.001). For patients who died in hospital, bridge patients were more likely to die in intensive care (100% vs 42%, P<.001). 
Conclusion: Patients on CIIS as bridge therapy may not receive surgical therapy due to frailty or development of identification of serious illnesses. These patients are less likely to receive palliative care or hospice and more likely to die in intensive care than patients on CIIS as palliative therapy.