National shortage of home intravenous inotrope agents: The “inotrope pandemic” continues

Despite an increase in the use of home inotropes, it has become progressively more difficult to coordinate inotrope therapy in the outpatient setting partly as a result of a change in reimbursement methodology as a result of the 21st Century Cures Act. Although prior call-to-actions have emphasized this growing concern, difficulties with arranging home inotropic therapy continue to mount. We sought to evaluate how this challenge has impacted patients listed for heart transplantation and any effects on patient management and listing strategy. An online survey was sent to all heart transplant programs throughout the United States and 53 programs (36% of active programs at time of survey) responded. Almost all programs were aware of the current inotrope shortage (n=50, 94%) with the majority (n=36, 68%) reporting an impact on current management. Increase in length of stay (n=28, 78%) were common with the majority of centers more likely to consider durable left ventricular assist device therapy rather than home inotropes as well as alternative listing strategies in-hospital, such as intra-aortic balloon pump and Impella devices, as bridges to transplantation. Of the programs not currently experiencing an impact, the majority anticipate experiencing such in the future with similar changes in patient management. Our findings highlight the on-going impact from the inotrope shortage and the changes in patient management that heart transplant programs are adopting.