Higher Risk-Standardized Inotrope Use Tracks to Longer Length of Stay

Updated:Apr 10,2014
American Heart Association/American Stroke Association
Latest Get With The Guidelines® Quality Research
 
Higher Risk-Standardized Inotrope Use Tracks to Longer Length of Stay
Hospital Variation in Intravenous Inotrope Use for Patients Hospitalized with Heart Failure: Insights from Get With The Guidelines®. Allen L, Fonarow G, Grau-Sepulveda M, Hernandez A, Peterson P, Partovian C, Li S, Heidenreich P, Bhatt D, Peterson E, Krumholz H. [Epub 1/31/2014] CIRCHEARTFAILURE.113.000761, doi: 10.1161/?CIRCHEARTFAILURE.113.000761
 
Key Points:
  • Among 209 hospitals participating in Get With The Guidelines®-Heart Failure (GWTG-HF) registry from 2005-2011, an inotropic agent was administered in 6.1% of heart failure hospitalizations: dobutamine (43%), dopamine (24%), milrinone (17%), or a combination (16%).
  • Use of inotropes varied significantly among hospitals, even after accounting for patient and hospital characteristics; the risk-standardized hospital use rate ranged from 1.3-32.9%.
  • After adjusting for case mix and hospital structural differences, 21% of the observed variation in inotrope use was potentially attributable to institutional preferences. 
  • Hospitals with higher risk-standardized inotrope use had modestly longer risk-standardized length of stay but had no difference in risk-standardized inpatient mortality.
Study Author:
Larry A. Allen, MD, MHS, grew up in Denver, completed medical school at Harvard, medicine residency at Massachusetts General Hospital, then cardiology fellowship at Duke with specialty training in transplantation and mechanical circulatory support. After a brief period on faculty at the Duke Clinical Research Institute, Dr Allen moved to his current position at the University Of Colorado School Of Medicine. Dr Allen splits his time between clinical duties in the Section of Advanced Heart Failure and Transplantation and research activities with the Colorado Cardiovascular Outcomes Research Consortium and Kaiser Institute for Health Research. Dr Allen’s goal is to promote appropriate and patient-centered use of therapies for heart failure, help patients and clinicians recognize the transition into advanced heart failure, and improve the quality of care for heart failure patients at the end of life.
 
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