LAUSR

Introduction Out-patient inotrope use has limited indications, but the extent of its actual use is not known. We used the SYMPHONY database of about 240 million people (2012-2018) to determine incidence of out-patient milrinone use & the nature of patients (pts) prescribed the medications. Methods Milrinone use was defined as at least 1 use of milrinone in an outpatient setting. To ensure that the drug was not given for testing purposes, no imaging event could be recorded on the same date as the milrinone use. Demographics were calculated, including geographic densities at the Metropolitan Statistical Area level. To estimate the total number of patients receiving these drugs in the US in 2016 & 2017, a population projection was performed to extrapolate from the database population to the total US Population. The projection was normalized based on age, gender & location. Results In 2016, there were 678 pts receiving milrinone as an out-patient in SYMPHONY, leading to a national projection of 1164 ± 96. In 2017, there were 580 pts, with a national projection of 975 ± 88. The SYMPHONY database is similar to census data with slightly less Medicaid and Medicare representation. The milrinone pts were older, more likely to be male, less likely to reside in the West and more likely to have Medicare. The mean age was 54 ± 21 years, with a median of 59 years. Concomitant medication use showed a relatively low prescription of cardiac medications. Loop diuretics were used in 58% of pts, beta adrenergic blockers in 51%, and ACE or ARB in 40%. ICD's were present in 45%, and LVAD's were placed in 8% of pts. More than 20% of pts had some indication of an acute event, with 10% having a morphine or fentanyl prescription, 5% with a prescribed hospital bed at home. Conclusion There is geographic variability in the use of home milrinone, and the patients receiving it are relatively young. While some use of home milrinone appears to be as a bridge to advanced heart failure treatment, much appears to be related to end of life care.