Document Detail


Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure.
MedLine Citation:
PMID:  19808355     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Eiran Z Gorodeski; Eric C Chu; Jennifer R Reese; Mehdi H Shishehbor; Eileen Hsich; Randall C Starling
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-05-14
Journal Detail:
Title:  Circulation. Heart failure     Volume:  2     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  320-4     Citation Subset:  IM    
Affiliation:
Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Cardiotonic Agents / 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:
1 KL2 RR024990/RR/NCRR NIH HHS; U01 AI063594-04/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine; 78415-72-2/Milrinone

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