Rehab on a Drip: A Case Series on Continuous Milrinone Infusion in Inpatient Rehabilitation

Background and/or Objectives: Patients with advanced heart failure exhibit severe symptoms with rest and exertion despite maximal medical therapy. These patients carry a poor prognosis and require advanced therapies including inotropes, mechanical circulatory support, and/or heart transplantation. Milrinone is a phosphodiesterase-3 inhibitor that exerts inotropic and vasodilatory effects. It is used during acute decompensation and as home therapy for palliation or bridge to definitive treatment. Studies have demonstrated benefit of milrinone in symptomatic relief, reduced hospitalizations, and enhanced quality of life, but there is a paucity of data examining this patient population completing inpatient rehabilitation.

Design: Retrospective, observational cohort study

Setting : Free-standing, academic, urban inpatient rehabilitation facility

Participants : 23 patients aged 33-76 (mean 61.2 ± 10.3) with heart failure managed with continuous milrinone infusion participated in inpatient rehabilitation between October 2019 and July 2023. 3 patients had prior heart transplantation and 8 patients had an LVAD. Average ejection fraction was 17.2% ± 6.9%.

Interventions: Patients engaged in a comprehensive inpatient rehabilitation program incorporating physical, occupational, and speech therapy tailored to the unique functional needs of each individual.

Main Outcome Measures: Mobility and self-care scores on section GG of the Functional Abilities and Goals of the Improving Post-Acute Care Transformation Act

Results: Length of stay ranged from 1-25 days (15.9 ± 6.6). The majority of patients (60.9%) were discharged home, while others (39.1%) required transfer to an acute care hospital. Patients who discharged home showed statistically significant improvements in self-care (GG0130) mean score from 22.2 to 35.4 (p = 0.001) and mobility (GG0170) mean score from 9.6 to 30.4 (p = 0.001). Patients requiring transfer to acute care still demonstrated statistically significant improvements in self-care (GG0130) mean score from 19.3 to 25.8 (p = 0.008) prior to transfer.

Conclusions: This unique and medically complex patient population can successfully participate in and benefit from a comprehensive inpatient rehabilitation program to achieve functional improvements.