Haider Warraich
speaker
683 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2021
Haider Warraich’s voice in public audio — every appearance, attributed to the second.
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Appearances
despite all of that.
I wouldn't be surprised as we have a proliferation of advanced therapies for heart failure that the use of these inotropes in this setting has also gone up.
Where we have seen it gone down is in the patient who is
still a candidate for advanced therapies such as an LVAD or a heart transplant, where I feel like in previous times where many of patients might have just been put on these medications, now they're now being considered for LVADs and other therapies because unlike inotropes, LVADs actually increase survival.
Well, I think as far as the mortality data is concerned, what I usually say is that we have no data to suggest that it increases mortality.
And then as far as quality of life is concerned, sometimes that can be hard to assess in the inpatient side where someone is in bed, isn't really doing much to begin with.
But essentially what I will say is that this is the only purpose of this medication is to help you feel better.
And if you feel better, that's great.
But then this is also a difficult therapy to manage.
You'll have to go home with IV inotropes, et cetera.
Is that something that you're willing to do based on this information?
And then if they say yes, then the next question often comes up is,
is hospice going to cover this?
And I've seen a lot of variation in this, you know, depending on where you live and what agencies are in your area, you might have agencies that cover inotropes maybe for a certain period of time versus you might not.
And which is why I think having these conversation early is helpful because then it can at least prevent you from running into these barriers at the end.
before a patient is being discharged.
And if a patient is being discharged off of inotropes, what I often will say is that if you're gonna veen this medicine, don't veen it too quickly, especially the day before someone's being discharged, because oftentimes patients get, their hemodynamics get used to these medications and then they can have a precipitous drop either before discharge or right thereafter.
You know, I found that, you know, again, Alex spoke to the power of hope.
And even when you present this information, there might be some patients who might feel like, well, you know, I want to take a chance at this medication, especially if it'll help me feel better.
You know, in that case, I think coming up with a plan, making sure you have a good, you know, some type of central access that is durable.
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