Abstract
The number of patients with heart failure (HF) in Japan is increasing and is projected to exceed 1.3 million by 2030. Patients with advanced heart failure may require continuous dobutamine (DOB) administration for hemodynamic support, and transitioning to home care is complicated by the complexity of drug management and safety concerns. In this case, an 80-year-old man with end-stage heart failure was transitioned to home care while continuing continuous DOB therapy using a portable infusion pump (CADD-Legacy). Despite attempts to reduce the DOB dose, delirium and hemodynamic instability became prominent, necessitating continued administration. To enable home care, a multidisciplinary team—including physicians, nurses, pharmacists, clinical engineers, medical social workers, and visiting nurses—collaborated to develop a protocol for home transition. Pharmacists were responsible for selecting appropriate infusion pumps, assessing drug compatibility, and standardizing preparation methods to ensure safe home administration. After an overnight stay outside the facility and a trial of the infusion pump during hospitalization, the suitability of the administration method was confirmed, and the patient was transferred to home care. This case demonstrates the role of pharmacists in home DOB therapy and highlights the importance of assessing drug compatibility, standardizing infusion administration, and ensuring safety and continuity of care. In view of the future expansion of HF home care, the establishment of standardized protocols and active pharmacist involvement are essential.
