Community Pharmacist Support for Complex Palliative Pharmacotherapy and Home Infusion in Advanced Heart Failure: A Case Report

Abstract

Advanced heart failure (HF) may require complex palliative pharmacotherapy, including continuous home infusion of inotropes, diuretics, and opioids, together with careful management of infusion devices, injectable-drug quality, compatibility, and symptom monitoring. However, practical reports describing community pharmacist involvement in such care remain limited, particularly from the pre-discharge phase. We report a case of end-of-life pharmacotherapy and home infusion for advanced HF supported by an interdisciplinary team. A 76-year-old man with stage D HF and inotrope dependence chose home-based care after repeated hospitalizations for decompensated HF. Before discharge, the community pharmacist contributed to device-operation training, aseptic compounding procedures, cassette-exchange scheduling, and contingency planning for continuous dobutamine infusion. During home care, the pharmacist coordinated cassette preparation and exchange, proposed a lightweight disposable pump for high-dose continuous furosemide infusion, implemented light protection for furosemide, supported lumen separation to avoid incompatibility with dobutamine, and prepared a morphine cassette for continuous subcutaneous infusion. Home infusion was continued until the patient died peacefully at home on Day 45. This case highlights the multifaceted role of community pharmacists in supporting complex palliative pharmacotherapy and home infusion for advanced HF.