Home inotrope therapy in chronic stimulant-induced cardiomyopathy: a case series

TL;DR

Home inotrope therapy can help manage chronic stimulant-induced cardiomyopathy by stabilizing patients and aiding recovery or preparing for advanced treatments.

Contribution

The paper introduces home inotrope therapy as a viable management option for chronic stimulant-induced cardiomyopathy.

Findings

Home inotrope therapy can stabilize patients with chronic stimulant-induced cardiomyopathy.

It serves as a bridge to advanced therapies like LVAD or heart transplantation.

It can also act as a psychosocial stress test for future treatment decisions.

Abstract

Patients with chronic stimulant-induced cardiomyopathy presenting with cardiogenic shock can be stabilized with conventional measures. However, their management post-stabilization has not been well described and poses unique challenges: (i) less chance of myocardial recovery compared to acute stimulant-induced cardiomyopathy, (ii) psychosocial barriers to left ventricular assist device (LVAD) and heart transplantation, and (iii) concern for use of peripherally inserted central catheter for home inotrope in those with a history of substance abuse.

Three patients with chronic stimulant-induced cardiomyopathy were admitted with cardiogenic shock progressing to Society for Cardiovascular Angiography & Interventions stage D or E. They were stabilized with inotrope and/or biventricular mechanical circulatory support. Long-term home inotrope was used as either a bridge to LVAD, reverse remodelling, or stabilization.

Home inotrope should be viewed as an option in chronic stimulant-induced cardiomyopathy on a case-by-case basis. It can buy time to allow for myocardial stabilization or recovery through goal-directed medical therapy and stimulant cessation. It can also serve as a ‘psychosocial stress test’ for future consideration of advanced heart failure therapies.

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