In advanced heart failure, long-term Intravenous Dobutamine Infusion (IDI) can be maintained for palliative purposes (destination therapy) for patients with a prognosis of less than 6 months. IDI can be performed at the hospital on an outpatient basis. Cardiac Rehabilitation (CR) is part of the treatment of heart failure. There are no data in the literature about CR management of patients treated with continuous IDI at home.

Evaluate the feasibility of CR and improvement in functional capacity and health-related quality of life in a patient treated at home with continuous IDI.

We present the case of a 73-year-old patient with advanced heart failure (LVEF 25–30%) Intermacs 3 profile, non-weanable from intravenous inotropes with recent episodes of cardiogenic shock. Continuous IDI via a PICC Line catheter in destination therapy was initiated on day 0. The patient was transferred on day 6 to a Cardiac Rehabilitation Unit (CRU). Administration of dobutamine on a morphine pump was done in relay to the automated continuous infusion pump, and a pump carrying bag was used to facilitate the patient's movements. A training program, including cardio-respiratory gymnastics, walking on flat ground, cycle ergometer with assistance, cardiac coherence, and relaxation, was set up. Hospitalization at home (HAH) and continuation of CR in day hospitalization or conventional hospitalization were performed. The patient subsequently suffered 3 episodes of cardiogenic shock leading to a temporary interruption of the CR plan and an increase in the output of the dobutamine pump from 2 to 4μg/kg/min. The patient died on day 577 after 20 months of IDI therapy.

No significant ventricular arrythmia nor vascular complications with the PICC Line catheter were reported during CR. Despite a gradual decline throughout the course of treatment, improvement of the patient's functional capacity and life quality was observed after each hospitalization, with the recovery of full autonomy for movement and low-level activities of daily living. The day hospitalization in CRU provided welcome respite periods for relatives.

CR of a patient with Intermacs 3 heart failure treated by palliative continuous IDI is feasible in conventional or day hospitalization combined with HAH. It needs technical adjustments. It intermittently improved the patient's functional capacities and health-related quality of life. This case report is encouraging for undertaking similar initiatives.