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

Gorodeski, Eiran Z.; Chu, Eric Chun-Pu; Reese, Jennifer R.; Shishehbor, Mehdi H.; Hsich, Eileen; Starling, Randall C.

doi:10.1161/circheartfailure.108.839076

Cited by 131 publications

(79 citation statements)

References 25 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: 55%

“…3 Inotropes are sometimes used in these patients, but despite evidence that they improve hemodynamics, continuous outpatient inotrope use has not been shown to improve survival, and in some cases has worsened survival, with studies reporting a 6-month mortality between 40% and 74%. [4][5][6][7] However, many inotrope trials predated the use of modern HF therapies, including implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy, aldosterone antagonists, and even β-blockers in some cases. These therapies may have altered the prognosis of patients on chronic inotropes.…”

mentioning

confidence: 99%

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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: 55%

mentioning

confidence: 99%

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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“…[15][16][17] The use of AI in adults has also been studied. [1][2][3][4][18][19][20] Although these studies are smaller, they did show that AI are feasible in the adult population. There is a reduced cost associated with AI compared with continued inpatient inotropic treatment.…”

Section: Discussionmentioning

confidence: 90%

“…3,18 However, as with inpatient treatment, mortality in the outpatient setting is substantial. 19 In particular, AI may be well suited in the adult population for palliative care in allowing patients to be discharged from the hospital who otherwise could not be and may potentially reduce rehospitalizations in this patient population. 21 These limitations have contributed to the increased use of mechanical circulatory support (MCS) in the adult patient.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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Background-Intravenous inotropic therapy can be used to support children awaiting heart transplantation. Although use of this therapy is discouraged in adults because of poor outcomes, its use in children, particularly outpatient, has had limited evaluation. We aimed to evaluate the safety and efficacy of this practice. Methods and Results-A retrospective analysis of an intent to treat protocol was completed on United Network for Organ Sharing status 1A patients discharged on inotropic therapy from 1999 until 2012. Intravenous inotropic therapy was initiated for cardiac symptoms not amenable to oral therapy. Patients who were not status 1A or required >1 inotrope were excluded. Efficacy was analyzed by time to first event: transplantation; readmission until transplantation; improvement leading to inotrope withdrawal; or death. Safety included analysis of infection rates, line malfunctions, temporary hospitalization, neurological events, and arrhythmias. One hundred six patients met inclusion criteria. The mean age was 10.1±6.4 years, 47% of patients had congenital heart disease, and 80% of these patients had single ventricle physiology.In patients without congenital heart disease, 53% had dilated cardiomyopathy, 91% of patients received milrinone, 85% of patients underwent transplantation, 8% of patients successfully weaned from support as outpatients, whereas 6% died. Fifty percent of patients were readmitted before transplantation or weaning from support, of which 64% required only 1 readmission. The majority of readmissions were for heart failure. Conclusions-Outpatient intravenous inotropic therapy can be safely used as a bridge to transplantation in pediatric patients.A minority of patients can discontinue inotropic therapy because of clinical improvement. (Circ Heart Fail. 2015;8:64-70.

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“…The statement recommends that the J-VAD risk score should be low or medium in patients <65 years, but should be exclusively low for those ≥65 years to satisfy DT eligibility. 13 Considering this recommendation, we defined patients who were ineligible for the bridge from extracorporeal VAD to I-LVAD for DT as follows: (1) those who died within 6 months post-LVAD; (2) those requiring BiVAD support; and (3) those with persistent organ dysfunction (medium or high J-VAD risk score) after 6 months' LVAD support.…”

mentioning

confidence: 99%

Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation　– For the Coming Era of Destination Therapy in Japan –

Nitta

Kinugawa

Imamura

et al. 2016

Circ J

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

Abstract: 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

Cited by 131 publications

References 25 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

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation　– For the Coming Era of Destination Therapy in Japan –

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

Abstract: 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

Cited by 131 publications

References 25 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

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation – For the Coming Era of Destination Therapy in Japan –

Contact Info

Product

Resources

About

Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation　– For the Coming Era of Destination Therapy in Japan –