Comparison of dobutamine-based and milrinone-based therapy for advanced decompensated congestive heart failure: Hemodynamic efficacy, clinical outcome, and economic impact

Yamani, Mohamad H.; Haji, Showkat A.; Starling, Randall C.; Kelly, Linda; Albert, Nancy M.; Knack, Deborah L.; Young, James B.

doi:10.1067/mhj.2001.119610

Cited by 90 publications

(55 citation statements)

References 13 publications

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“…7,24,[36][37][38] In this study, patients on milrinone had higher survival than those on dobutamine. However, given the small number of patients on dobutamine and potential differences in patient selection and characteristics that could have influenced outcomes, we are unable to make a robust claim about the independent effect of milrinone versus dobutamine on survival.…”

Section: Discussionmentioning

confidence: 77%

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Hashim

Sanam

Revilla-Martinez

et al. 2015

Circ: Heart Failure

115

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Background-Inotrope use in heart failure treatment was associated with improved symptoms, but worse survival in clinical trials. However, these studies predated use of modern heart failure therapies. This study evaluates contemporary outcomes on long-term inotropes. Methods and Results-We collected baseline and postinotrope data on 197 patients discharged on inotropes between January 2007 and March 2013. Baseline characteristics, hemodynamic and clinical changes on inotropes, and survival were evaluated. Patients initiated on inotropes had refractory heart failure, with median baseline New York Heart Association class IV, cardiac index of 1.7 L/min per m 2 , pulmonary capillary wedge pressure of 25.6 mm Hg, and left ventricular ejection fraction of 18.7%. Inotropes were used in patients listed for transplant or scheduled for left ventricular assist device (LVAD; 60 patients), in patients being evaluated for LVAD/transplant (20 patients), for stabilization pending cardiac resynchronization therapy/percutaneous coronary intervention (4 patients), in patients who were offered LVAD but chose inotropes (15 patients), and for palliation (98 patients). Milrinone was used in 84.8% and dobutamine in 15.2%. At the end of the study, 68 patients had died, 24 were weaned off inotropes, 23 were transplanted, 32 received LVADs, and 50 remained on inotropes. Patients who received inotropes for palliation or those who preferred inotropes over LVAD had median survival of 9.0 months (interquartile range, 3.1-37.1 months), actuarial 1-year survival of 47.6%, and 2-year survival of 38.4%. Of 60 patients who were placed on inotropes as a bridge to transplant/LVAD, 55 were successfully maintained on inotropes until transplant/LVAD. Conclusions-Survival on inotropes for patients who are not candidates for transplant/LVAD is modestly better than previously reported, but remains poor. Inotropes are effective as a bridge to transplant/LVAD. (Circ Heart Fail.

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Section: Discussionmentioning

confidence: 77%

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Hashim

Sanam

Revilla-Martinez

et al. 2015

Circ: Heart Failure

115

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“…Dobutamine remains a cornerstone of therapy for low-output states with elevated cardiac filling pressures including ADHF and cardiogenic shock. For acute management of these patients, the clinical outcomes of dobutamine appear to be comparable with milrinone (11).…”

Section: Catecholaminesmentioning

confidence: 98%

“…Milrinone has shown a greater vasodilatory effect than dobutamine, as demonstrated by further reductions in mean pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP) and SVR. In fact, dobutamine may need to be combined with nitroprusside to exert a similar degree of vasodilation (11). On the other hand, dobutamine may increase CO to a greater extent than milrinone, but at the expense of greater increases in heart rate and myocardial oxygen consumption.…”

Section: Phosphodiesterase Inhibitorsmentioning

confidence: 99%

Review and update on inotropes and vasopressors: Evidence-based use in cardiovascular diseases

Kalçık¹,

Gürsoy²

2015

Curr Res Cardiol

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Patients in the intensive care unit frequently develop low-output syndromes due to cardiac dysfunction, myocardial injury and activation of inflammatory cascades. Pharmacological agents, including vasodilators, inotropes and vasopressors, are frequently used in the critical care setting for the management of unstable cardiac patients. These medications are used to elicit varying effects on vascular resistance, myocardial contractility and heart rate to achieve desired hemodynamic and clinical end points. Conventional inotropic agents appear to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion, but they can increase short-term and long-term mortality in these patients. Novel inotropes may be promising in the management of cardiogenic shock patients without serious adverse effects. The present review summarizes the current knowledge about the pathophysiology and evidence-based use of conventional and novel inotropic agents in various clinical scenarios associated with cardiovascular diseases.

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“…12 Several previous studies examined inotrope use in patients with end-stage HF, but none compared the rate of death with the inotrope choice. Their focus was mainly on clinical feasibility, 12-15 safety, 15 cost-effectiveness and resource utilization, 12,16,17 and as a bridge to transplantation or for palliation. 12,14,15,18 We present new information on a common clinical dilemma: the prognostic implications of choosing between dobutamine and milrinone for patients with stage D HF being discharged from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Prognosis on Chronic Dobutamine or Milrinone Infusions for Stage D Heart Failure

Gorodeski

Chu

Reese

et al. 2009

Circ: Heart Failure

Self Cite

131

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Comparison of dobutamine-based and milrinone-based therapy for advanced decompensated congestive heart failure: Hemodynamic efficacy, clinical outcome, and economic impact

Cited by 90 publications

References 13 publications

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure

Review and update on inotropes and vasopressors: Evidence-based use in cardiovascular diseases

Prognosis on Chronic Dobutamine or Milrinone Infusions for Stage D Heart Failure

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