Abstract Continuous ambulatory intravenous inotropes can be successfully used as a bridge to decision or heart transplant in patients with end-stage heart failure. The traditional model at our institute involved the Hospital in the Home (HITH) team, with daily nurse-led visits to the patients’ home, to safely maintain this treatment, which is otherwise largely restricted to the intensive care setting. In response to the COVID-19 pandemic, delivery of healthcare underwent a paradigm shift. Our model was changed to a patient led continuous intravenous inotrope program at home which obviated the need for a daily nurse visit. We describe our process and our early outcomes. Fifteen patients were deemed suitable for the Independent at Home program. All patients needed to complete ambulatory intravenous inotrope education, pass competency testing and have implantable cardioverter-defibrillators inserted prior to discharge. Competencies included proficiency for troubleshooting the inotrope ambulatory delivery pump, monitoring of vital signs and ability to report decompensated heart failure symptoms. Weekly outpatient visits to our heart failure clinic with nursing, medical and pharmacy reviews were scheduled. Emergency action plans were provided to patients. 73.3% of our cohort were male. The average age was 51 years. 46.6% had a diagnosis of dilated cardiomyopathy. 53.3% were listed for heart transplant and were bridge to transplant (BTT) and 46.7% were bridge to decision (BTD) for heart transplant. Over a study period of 35 months, seven (46.7%) patients were weaned off inotropes, three (20.0%) were escalated to durable mechanical circulatory support (one due to decompensated heart failure and two due to persistently elevated pulmonary pressures), four (26.7%) were transplanted and one (6.7%) chose to be palliated. Six patients had one admission, five patients had two admissions. Five readmissions were due to decompensated heart failure, four admissions were planned to optimize pulmonary hypertension following a right heart catheterization, three had peripherally inserted central catheter (PICC) line complications and two had non-cardiac admissions (refer to table 1). The median length of days on the Independent at Home program was 112 days with an interquartile range of 120 days. A comparative group consisting of consecutive patients treated under the previous Hospital in the Home model are presented in table 2; the Independent at Home cohort shows reduced unplanned admissions. The independent at home inotrope program is an effective and safe option to bridge to decision or bridge to cardiac transplantation.HITH vs Independent admission reasonHITH vs Independent admissions

Abstract Background Home inotropic support is an established bridge to cardiac transplantation in patients with advanced heart failure. Milrinone, a phosphodiesterase 3 inhibitor, preferentially vasodilates pulmonary vasculature, thus is often chosen over dobutamine in patients with concomitant pulmonary hypertension. However, there is a paucity of data on the haemodynamic effects of milrinone in the pre-cardiac transplant population. Purpose We sought to examine the haemodynamic effects of milrinone vs. dobutamine out to 3 months in patients with advanced heart failure awaiting cardiac transplantation. Methods Patients in the home inotrope program at a quaternary referral centre from January 2000 to May 2022 were included. Retrospective analysis of echocardiographic and invasive haemodynamic studies via right heart catheterisation were performed at baseline (prior to commencement of inotrope), at 30 days (30D) and 3 months (3m). Results From a total of 119 patients, 57 were on milrinone and 62 on dobutamine. Non-ischaemic cardiomyopathies of various aetiologies accounted for 67%, while ischaemic cardiomyopathies accounted for 33%. Majority of patients were male (79%) with a mean age of 52±13 years. There was a significant increase in LVEF from 21±7% at baseline to 27±14% at 3m in those on dobutamine, p = 0.02. Similar increase in LVEF from 22±8% to 26±13% in the milrinone group did not reach significance, p = 0.43. Comparably, CI increased from 2.0±0.6L/min/m2 at baseline to 2.5±0.9L/min/m2 at 3m in the dobutamine cohort, p = 0.05, and from 2.0±0.7L/min/m2 at baseline to 2.3±0.6L/min/m2 at 3m in the milrinone cohort, p = 0.27. In the dobutamine cohort LVEDD was static from 68±14mm at baseline to 66±21mm at 3m, p = 0.78. LVEDD reduced from 67±11mm to 60± 9mm at 3m in the milrinone group, p = 0.09. Classification of mild right ventricular dysfunction increased from 7% to 18% after 30 days on milrinone, p= 0.2, compared to an increase from 10% to 16% in the dobutamine group, p = 0.47. Mean pulmonary artery pressure (mPAP) reduced from 34±11mmHg to 29±11mmHg at 3m in the milrinone group, p = 0.15. mPAP was static in the dobutamine group from 34±9mmHg at baseline to 34±10mmHg at 3m, p = 0.96. TPG in the milrinone group was 11.9±6.0mmHg to 12.9±6.3mmHg at 30D, with reduction at 3m to 9.6±6.3mmHg, p = 0.26. In the dobutamine group TPG remained static from 10.9±5.7mmHg at baseline to 11.4±5.1mmHg at 30D and 10.9±5.2 at 3m, p = 0.97. Wedge pressure (PCWP) reduced from 22±7mmHg at baseline to 21±7mmHg at 30D to 18±8mmHg at 3m in the milrinone group, p = 0.11. PCWP in the dobutamine group was static at 23±8mmHg at baseline to 24±5mmHg at 30D and 23±6mmHg at 3m, p = 0.92. Conclusion(s) Dobutamine demonstrated a significant increase in LVEF and CI out to 3 months, however milrinone demonstrated a larger improvement in RV function and greater reduction in cardiac and pulmonary pressures as compared to dobutamine. Larger studies are required to confirm these trends.Figure 1

Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.

The Hubble Catalog of Variables (HCV) project aims to identify the variable sources in the Hubble Source Catalog (HSC), which includes about 92 million objects with over 300 million measurements detected by the WFPC2, ACS and WFC3 cameras on board of the Hubble Space Telescope (HST), by using an automated pipeline containing a set of detection and validation algorithms. All the HSC sources with more than a predefined number of measurements in a single filter/instrument combination are pre-processed to correct systematic effect and to remove the bad measurements. The corrected data are used to compute a number of variability indexes to determine the variability status of each source. The final variable source catalog will contain variables stars, active galactic nuclei (AGNs), supernovae (SNs) or even new types of variables, reaching an unprecedented depth (V$\leq$27 mag). At the end of the project, the first release of the HCV will be available at the Mikulski Archive for Space Telescopes (MAST) and the ESA Hubble Science Archives. The HCV pipeline will be deployed at the Space Telescope Science Institute (STScI) so that an updated HCV may be generated following future releases of HSC.

We aim to construct an exceptionally deep (V ≲ 27) catalog of variable objects in selected Galactic and extragalactic fields visited multiple times by the Hubble Space Telescope (HST). While HST observations of some of these fields were searched for specific types of variables before (most notably, the extragalactic Cepheids), we attempt a systematic study of the population of variable objects of all types at the magnitude range not easily accessible with ground-based telescopes. The variability timescales that can be probed range from hours to years depending on how often a particular field has been visited. For source extraction and cross-matching of sources between visits we rely on the Hubble Source Catalog which includes 107 objects detected with WFPC2, ACS, and WFC3 HST instruments. The lightcurves extracted from the HSC are corrected for systematic effects by applying local zero-point corrections and are screened for bad measurements. For each lightcurve we compute variability indices sensitive to a broad range of variability types. The indices characterize the overall lightcurve scatter and smoothness. Candidate variables are selected as having variability index values significantly higher than expected for objects of similar brightness in the given set of observations. The Hubble Catalog of Variables will be released in 2018.