Intermittent dobutamine therapy in patients with advanced congestive heart failure

Ferroni, C.; Fraticelli, Aureliano; Paciaroni, E

doi:10.1016/s0167-4943(96)00739-x

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Of the remaining 110 studies, 41 met the predetermined inclusion criteria and were therefore included in this review. A total of 41 studies 9,10,13–51 were included in the single-arm meta-analysis, of which 18 RCTs 9,13–29 were included in the network meta-analysis. Figure 1 shows the PRISMA flowchart.…”

Section: Resultsmentioning

confidence: 99%

“…13,15–19,21,23,25,28 Of the 18 randomized controlled trials, 3 (17%) had some degree of bias due to allocation concealment problems, 9,16,23 6 (33%) had some degree of bias due to subject and staff blinding, 9,13,16,19,23,29 and 3 (17%) had other biases. 9,14,26 As shown in Supplemental Digital Content 1 (see Table S3 , http://links.lww.com/JCVP/B74), 23 cohort studies 10,30–51 were of good quality according to the Newcastle‒Ottawa Scale. No bias was indicated for the reporting of BNP and supraventricular tachyarrhythmia in network analysis because the number of trials reporting these outcomes was less than 10 per comparison.…”

Section: Resultsmentioning

confidence: 99%

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Comparative Effectiveness and Safety of Intermittent, Repeated, or Continuous Use of Levosimendan, Milrinone, or Dobutamine in Patients With Advanced Heart Failure: A Network and Single-Arm Meta-analysis

Zhang,

Wang,

Zhang

et al. 2024

Journal of Cardiovascular Pharmacology

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To synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure (HF). We systematically searched the PubMed, Embase, and Cochrane Library electronic databases, with a cutoff date of November 23, 2023, for studies reporting outcomes in adult patients with advanced HF treated with intermittent, repeated, or continuous levosimendan, milrinone, or dobutamine. Forty-one studies (18 randomized controlled trials and 23 cohort studies) comprising 5137 patients met the inclusion criteria. The results of the network meta-analysis of randomized controlled trials showed that levosimendan had significant advantages over milrinone or dobutamine in reducing mortality and improving LVEF. A single-arm meta-analysis also indicated that levosimendan had the lowest mortality and significantly improved BNP and LVEF. Regarding safety, hypotension events were observed more frequently in the levosimendan group and milrinone groups. However, the current evidence is limited by the heterogeneity and relatively small sample size of the studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparative Effectiveness and Safety of Intermittent, Repeated, or Continuous Use of Levosimendan, Milrinone, or Dobutamine in Patients With Advanced Heart Failure: A Network and Single-Arm Meta-analysis

Zhang,

Wang,

Zhang

et al. 2024

Journal of Cardiovascular Pharmacology

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“…While all studies demonstrated an improvement in NYHA functional class on inotropes, heterogeneity was high (I 2 =89%). NYHA functional class improved in studies(23,26,27) that treated patients with inotropes as palliative therapy (mean −1.1 class, 95% CI 0.8, 1.3, I 2 =0%) and as BTT (mean −1.3 classes, 95% CI 1.2–1.4, I 2 =0%)(21,28,29).…”

Section: Resultsmentioning

confidence: 99%

Ambulatory Inotrope Infusions in Advanced Heart Failure

Nizamic

Murad

Allen

et al. 2018

JACC: Heart Failure

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“…Palliative inotropes likely improve functional status and symptoms, with most studies showing an improvement in NYHA functional class by about 1 functional class with outpatient inotrope therapy (both bridge and palliative) . However, it is unclear whether palliative inotropes improve functional status when compared with placebo …”

Section: How Should Patients Be Counseled About the Risks And Benefit...mentioning

confidence: 99%

Palliative Inotrope Therapy

et al. 2019

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eart failure (HF) affects more than 6 million individuals in the United States, 1,2 only a small fraction of whom receive heart transplant (HT) or mechanical circulatory support (MCS) such as left ventricular assist devices (LVADs). [3][4][5][6] Patients with advanced or stage D HF are subject to exceptionally high mortality. In a 2018 contemporary study of 969 patients with advanced HF who had not previously received advanced therapies or inotropes, 3-year mortality rate ranged from 26% to 44% depending on the severity of clinical presentation. 7 However, epidemiologic data about survival in patients with advanced HF are very limited. Importantly, patients with symptomatic HF also have significant morbidity, experiencing a similar burden of physical and depressive symptoms to patients with advanced cancer. 8 For a subset of patients with advanced HF with reduced ejection fraction (HFrEF), ambulatory intravenous inotropic support may be considered as a palliative therapy.Concerns about harm have generally kept continuous ambulatory inotrope use low in the last 2 decades. 9 However, presumably owing to ongoing unmet palliative needs and some recent publications about the potential benefit of targeted use for palliation, between 2010 and 2014, there was a 63% (from approximately 1200 to 2000 beneficiaries) and 44% (from approximately 400 to 575 beneficiaries) increase in the number of Medicare beneficiaries re-ceiving home milrinone and home dobutamine, respectively. 10 Still, health care professionals face uncertainty when considering initiation of ambulatory inotropes for palliation, given the paucity of robust data and guideline support as well as logistical issues, particularly if hospice is also desired. [11][12][13][14] The purpose of this review is to provide guidance to clinicians on initiation, selection, maintenance, and weaning or withdrawal of chronic inotropes and the management of concurrent therapies in the modern HF landscape. Historical PerspectiveIn the 1970s and 1980s, several studies demonstrated positive effects of intravenous inotropes on hemodynamics and symptoms. [15][16][17] Subsequent trials in the 1990s and early 2000s, including PROMISE, 18 FIRST, 19 VEST, 20 OPTIME, 21 and REVIVE II, 22 showed that the use of intravenous or oral inotrope therapy in acute or chronic HF was consistently associated with decreased survival and/or an increased risk of adverse cardiovascular events. In some of these studies, 6-month mortality was in excess of 50%.However, those studies were not designed to address use of inotropes as palliation. They also preceded the current era of modern HF therapies including implantable cardioverter defibrillators (ICDs), IMPORTANCE The number of patients living with end-stage heart failure is steadily growing, and ambulatory intravenous inotropic support is increasingly offered as a palliative therapy. However, the optimal ways to initiate, manage, and discuss the risks and benefits of palliative inotropes in the current era of heart failure care are unclear.OBSERVATION...

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Intermittent dobutamine therapy in patients with advanced congestive heart failure

Cited by 6 publications

References 19 publications

Comparative Effectiveness and Safety of Intermittent, Repeated, or Continuous Use of Levosimendan, Milrinone, or Dobutamine in Patients With Advanced Heart Failure: A Network and Single-Arm Meta-analysis

Comparative Effectiveness and Safety of Intermittent, Repeated, or Continuous Use of Levosimendan, Milrinone, or Dobutamine in Patients With Advanced Heart Failure: A Network and Single-Arm Meta-analysis

Ambulatory Inotrope Infusions in Advanced Heart Failure

Palliative Inotrope Therapy

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