Abstract 13262: A Self-Administered Home Inotrope Program for Unfunded Patients With End-Stage Heart Failure

Introduction: Uninsured patients with inotrope-dependent end-stage heart failure (HF) pose a formidable challenge to the healthcare system and innovative solutions are required. We created a health system funded home program for palliative and bridge-to-funding inotrope strategies for unfunded patients. Herein, we report our updated experiences.

Methods: We reviewed records of all patients enrolled in the home inotrope program since inception in 2019. Patients must have demonstrated a low cardiac index that was stabilized on a single inotrope. Advanced HF and palliative care consultations are mandatory. Next, a multidisciplinary team educates the patient via a teach-teach back method on how to self-administer intravenous inotropes via a provided continuous infusion pump. After discharge, patients attended weekly clinic appointments for assessment and dressing changes. Clinic appointments, supplies, and medications are provided by the health system at minimal cost to the patient. This project was deemed IRB exempt as a quality improvement project.

Results: Thus far the program has enrolled 15 uninsured patients through April 24, 2023 (table). The median duration of inotropic support was 70 (32-143) days. Patients remained at home for 90% of the 1500 total supported days. To date, one patient has received a heart transplant and three patients have received LVAD surgery after obtaining health insurance. Three (20%) patients experienced a catheter-associated infection, with two developing bacteremia. All patients endorsed satisfaction with increased time spent outside of the hospital. This was estimated to have saved >$2,363,000 in self-pay discounted charges for a general care telemetry bed and >$586,000 in professional charges (CPT 99233, estimates via price transparency act).

Conclusion: A self-administered home inotrope program for select patients is feasible, safe, and cost-effective. It may also serve as a bridge to funding for advanced therapies.