Dr. Luanda Grazette

The diagnosis of advanced heart failure seems so scary that many associate this with an immediate death sentence.

“Once someone is diagnosed, they often hear they have one year to live, and that’s simply not true with current therapy,” said Luanda Grazette, MD, MPH, FACC, associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California. “It’s a chronic condition, but one that people can often live with for many years. Whatever treatment approach works best and provides the best quality of life is what we should do.”

For Grazette, that increasingly means prescribing home infusion inotropic medication. The medication helps the hearts of patients with advanced heat failure beat more efficiently.

In addition to the massive quality of life benefit of receiving care at home, home infusion therapy – medication administered via a needle or catheter — is safe, effective and often less costly than inpatient care. But patient access to high quality home infusion is at risk because of an unintended consequence of the 21st Century Cures Act, passed by the U.S. Congress and signed into law in December 2016. The Cures Act creates a gap in Medicare coverage for certain home infusion drugs.

Take action to amend the Cures Act

Grazette believes that home inotropic infusion is currently an underutilized therapy. “It was initially used as a bridge to a heart transplant and rarely used for palliation,” she said. “It’s an area that has received very little attention and introspection in the medical community.”

Grazette said inotropic home infusion has the potential to improve physical and mental health.

“For select patients, it’s night and day,” she said. “We’ve had patients that were able to increase their activity and actually their overall physical condition. It also improves the quality of life because patients can engage with their families and connect to the world in a way they wouldn’t be able to if they were hospitalized.”

If some patients no longer can receive this treatment at home, Grazette expects that some patients would need care in the hospital.

“There may be an increase in hospitalizations,” she said. “It’s a burden for the healthcare system but also a burden for patients to not be able to access the medication that they need.”




“For select patients, it’s night and day… We’ve had patients that were able to increase their activity and actually their overall physical condition.”