Document Detail

Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure.
MedLine Citation:
PMID:  19808355     Owner:  NLM     Status:  MEDLINE    
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.
Eiran Z Gorodeski; Eric C Chu; Jennifer R Reese; Mehdi H Shishehbor; Eileen Hsich; Randall C Starling
Related Documents :
22551105 - Warfarin and aspirin in patients with heart failure and sinus rhythm.
22674875 - Physiotherapy rehabilitation for individuals with lower limb amputation: a 15-year clin...
18774005 - Continuous quality improvement program and major morbidity after cardiac surgery.
22330165 - Potent and sustained antiviral response of raltegravir-based highly active antiretrovir...
22146975 - Endovascular treatment of malignant superior vena cava syndrome: results and predictive...
1540455 - Hypoxaemia is reduced by pulse oximetry monitoring in the operating theatre and in the ...
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    
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:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Cardiotonic Agents / administration & dosage*
Dobutamine / administration & dosage*
Heart Failure / drug therapy*,  mortality*
Infusions, Intravenous
Middle Aged
Milrinone / administration & dosage*
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Grant Support
1 KL2 RR024990/RR/NCRR NIH HHS; U01 AI063594-04/AI/NIAID NIH HHS
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine; 78415-72-2/Milrinone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Serum levels of the interleukin-1 receptor family member ST2, cardiac structure and function, and lo...
Next Document:  Expression patterns of cardiac myofilament proteins: genomic and protein analysis of surgical myecto...