| Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure. | |
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MedLine Citation:
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PMID: 19808355 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: There are no published clinical trials comparing dobutamine with milrinone in outpatients with stage D heart failure on continuous inotropes. METHODS AND RESULTS: In a retrospective analysis of 112 inotrope-dependent patients with stage D heart failure who were not transplant candidates at enrollment, we investigated the relationship between choice of dobutamine or milrinone and mortality. Half the patients were on dobutamine (mean dose, 5.4+/-2.5 microg/kg per minute) and half on milrinone (mean dose, 0.4+/-0.2 microg/kg per minute). Those on dobutamine tended to be older (63 years old versus 54 years old), male (86% versus 79%), and fewer had implantable cardioverter-defibrillators (57% versus 74%). During a median follow-up time of 130 days (range, 2 to 2345 days), there were 85 deaths (76% of cohort) and 55 rehospitalizations. Use of dobutamine compared with milrinone was associated with higher all-cause mortality in an unadjusted analysis (hazard ratio [HR], 1.63; 95% CI, 1.06 to 2.52; P<0.03). However, this association was not significant after adjustment for baseline characteristics in the full cohort (N=112; HR, 0.99; 95% CI 0.5 to 1.97; P=0.98) or propensity-matched cohort (N=70; HR, 0.94; 95% CI 0.48 to 1.85; P=0.86). CONCLUSIONS: In this single-center retrospective study, there were no mortality differences between chronic intravenous dobutamine or milrinone in patients with stage D heart failure being discharged from the hospital. The high mortality in this group selected for inotrope dependence warrants careful consideration of all options and priorities for further care. |
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Authors:
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Eiran Z Gorodeski; Eric C Chu; Jennifer R Reese; Mehdi H Shishehbor; Eileen Hsich; Randall C Starling |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2009-05-14 |
Journal Detail:
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Title: Circulation. Heart failure Volume: 2 ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2009 Jul |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-11-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: United States |
Other Details:
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Languages: eng Pagination: 320-4 Citation Subset: IM |
Affiliation:
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Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cardiotonic Agents
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administration & dosage* Dobutamine / administration & dosage* Female Heart Failure / drug therapy*, mortality* Humans Infusions, Intravenous Male Middle Aged Milrinone / administration & dosage* Retrospective Studies Severity of Illness Index Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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1 KL2 RR024990/RR/NCRR NIH HHS; U01 AI063594-04/AI/NIAID NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 34368-04-2/Dobutamine; 78415-72-2/Milrinone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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