Patients in end-stage
heart failure can experiment
cardiogenic shock and may not be weanable from
dobutamine. The fate of these patients is a challenge for doctors, patients, family, and the institution.
Dobutamine use at home can be a
solution. The aim of the present study was to assess the outcome,
biological predictors, and safety of
dobutamine use at home in
dobutamine-dependent patients. All consecutive
dobutamine-dependent patients discharged with continuous home intravenous
dobutamine, from a single tertiary center between February 2014 and November 2019, were retrospectively analyzed. A total of 19 patients (age 65 ± 10 years) were followed for one year. At one-year, the survival rate was 32%, (6/19). Five (26%) patients had an adverse event related to the intravenous
catheter. In a multivariate logistic regression analysis, the combination of a glomerular filtration rate >60 mL/min and a
brain natriuretic peptide level <1000 ng/L, were highly predictive of one-year survival (HR = 10.87, IC95% (5.78-36.44), p < 0.001). Management of
dobutamine-unweanable patients after
cardiogenic shock may involve
dobutamine at home to permit a home return. This strategy allows a significant survival and few readmissions, and, if eligible, access to surgical strategies, such as
heart transplantation. Simple
biological markers at discharge can identify severe patients to refer to
palliative care and good responders.