Reassessment of Dobutamine, Dopamine, and Milrinone in the Management of Acute Heart Failure Syndromes

Bayram, Melike; Luca, Leonardo De; Massie, M. Barry; Gheorghiade, Mihai

doi:10.1016/j.amjcard.2005.07.021

Cited by 209 publications

(120 citation statements)

References 69 publications

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“…Inodilator therapy was defined by administration of dobutamine and/or phosphodiesterase inhibitors (milrinone), and was used in 66 (93%) of patients. Vasopressor therapy, defined by administration of adrenaline and/or dopamine !5 mg/kg min [4,5] and/or norepinephrine, and was noted in 47 (66%) patients. Twenty-two (31%) patients had preoperative intraaortic balloon counter-pulsation (IABC) that was initiated at a mean of 1.2 AE 1.3 (extremes, 0-5) days before MCS.…”

Section: Preimplantation Supportmentioning

confidence: 99%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Background: Mechanical circulatory support has become a well-established procedure for some patients with cardiogenic shock. However, patient selection and timing of implantation remains critical. This retrospective study was undertaken to identify preoperative predictors of survival in ICU of patients requiring mechanical circulatory support. Methods: Between 1996 and 2006, 71 patients (61 men, 10 women, aged 41.6 AE 12.2 years) with primary cardiogenic shock were assisted using the paracorporeal Thoratec W VAD. Twenty-seven (38%) patients needed preoperative mechanical ventilation. Preoperative IV hemodynamic drug support included dobutamine in 63 (89%), vasopressors (adrenaline, noradrenaline or dopamine !5 mg/kg min) in 47 (66%), and intraaortic balloon counter-pulsation in 22 (31%) patients. Mean preoperative blood creatinine and total bilirubin levels were 162.2 AE 72.4 mmol/l and 36.4 AE 53.9 mmol/l, respectively. Results: Fifty-six (79%) patients required biventricular and 15 (21%) left ventricular support. Patients were assisted for a mean duration of 73.1 AE 93.6 days (extremes, 1-480 days). Twenty-five patients (35%) died while on support. Among these, 18 patients (25%) never recovered sufficiently to allow dismissal from ICU, and died after a mean of 15.4 AE 14.3 days. Logistic regression identified preoperative IV adrenaline as sole predictor for ICU death (OR, 5.48; 95% CI,, p = 0.012). Conclusions: The need for preoperative IV adrenaline therapy appeared to be the sole independent risk factor for death in ICU in patients assisted with the Thoratec W paracorporeal VAD. This suggests that, besides hemodynamic and metabolic consequences of cardiogenic shock, preoperative activation of the inflammatory cascade could influence the prognosis of patients undergoing mechanical circulatory support. #

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Section: Preimplantation Supportmentioning

confidence: 99%

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Kirsch

Vermès

Radu

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…This is the case with the attribution of the side effect "death" to thalidomide's use in complex myeloma multiplex, when this reflects the high mortality rate of the disease itself 31 . Naturally, there are some cases where use of a drug can increase death rate, even in treating life-threatening diseases, such as the case of milrinone for acute heart failure syndromes (AHFS) 53 or severe chronic heart failure 54 . Accordingly, the category "outcome" should be used cautiously for ADR analysis, especially in large-scale studies that aggregate data from several drugs.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Reverse Translation for Preclinical Off-Target Mitigation: Quantification and Mitigation of Biases in the FDA Adverse Event Reporting System

Maciejewski

Lounkine

Whitebread

et al. 2016

Preprint

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Abstract-The Food and Drug Administration Adverse EventReporting System (FAERS) is the primary source for postmarketing pharmacovigilance. Though potentially highly useful, the database reflects reporting biases, stimulated reporting, and suffers from lack of standardization and the use of multiple drug synonyms. These biases can suggest adverse drug reactions (ADRs) where none exist, and can obscure others that do exist. To decrease the noise in FAERS, and to reinforce important associations, we mapped over 750,000 drug identifiers in FAERS to the normalized chemical structures of their ingredients. This illuminated associations that would not otherwise be apparent, and also allowed a time-resolved analysis of ADR reporting. It also revealed similarities between drugs and adverse events across therapeutic classes, enabling unbiased classification of adverse events, indications, and drugs with similar clinical profiles. For instance, comparison of two selective cyclooxygenase-2 inhibitors, celecoxib and rofecoxib finds distinctive FAERS profiles after time-resolved analysis. We also investigated key idiosyncrasies, such as confusion between drug indications and drug ADRs, which can tar a drug treating a life-threatening disease, like thalidomide's use against myeloma, with a deadly ADR that is likely the result of the disease itself, multiplications of the same report, which unjustifiably increases its apparent importance, and the correlation of reported ADRs with public events, regulatory announcements, and with publications. Comparing the pharmacological, pharmacokinetic, and clinical ADR profiles of methylphenidate, aripiprazole and risperidone, and of kinase drugs targeting the VEGF receptor (VEGF-R2), demonstrates how underlying molecular mechanisms can emerge from ADR co-analysis. The precautions and methods we describe may enable investigators to avoid confounding chemistry-based associations and reporting biases in FAERS, and illustrate how comparative analysis of ADRs can reveal underlaying mechanisms.

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“…Pharmacists can assist in the evidence-based selection of drug therapy by making every therapeutic decision with diligence, to avoid potentials for long-term morbidity and mortality [27,28] , and improving guideline compliance in patients with heart failure [29] . The findings of a survey among pharmacists suggest that higher involvement of pharmacists in post-discharge patients, would yield improvement in adherence issues [30] .…”

Section: Discussionmentioning

confidence: 99%

Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria

Ajuluchukwu

Emmanuel

Raji

2013

JHA

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Background: The increasing need for adherence evaluation of CHF amongst senior physicians in our environment prompted this study.Objective: To determine physician-adherence to pharmacotherapy guidelines in CHF in an economically resource-poor tertiary health facility. Methods:Review of prescription pattern of anti-CHF drug-class of 100 confirmed systolic-CHF patients was carried out. Data for adherence-evaluation were obtained from follow-up information from out-patient clinic-notes, while data on acute care medications and precipitating factors were from in-patient hospitalization notes.Results: CHF patients aged 54.7 ± 14.5 years, had NYHA III/IV symptoms (47%) and hypertension (61%). Anti-CHF pharmacotherapy averaged three drug-types; and consisted of ACEI/ARB (83%), β blockers-BB (48%), aldosterone antagonists (41%), CG (82%), and diuretics (75%). Adherence was assessed as good or complete in 50%, partial/ incomplete in 33%; but non-adherent in 17% of the total. While overall physician-adherence was 59.6% on single drug-classes, survival-advantage combinations with ACEI/ARB+BB and ACEI/ARB+BB+AA were present in 40% and 16% respectively. Older patients (≥ 65 years) had significantly lower prescriptions of all three classes of survival advantage anti-HF drugs, as follows: ACEI/ARB (56% versus 95%); BB (37.5% versus 52%); and AA (31% versus 63%) [p < .05].Conclusion: BB and AA were under-prescribed. Physician-adherence to evidence-based anti-HF drug classes was variable and influenced by patient's age. It was also comparable with reports from other countries. Our physicians will benefit from a structured HF education and feed-back program.

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Reassessment of Dobutamine, Dopamine, and Milrinone in the Management of Acute Heart Failure Syndromes

Cited by 209 publications

References 69 publications

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

Impact of preoperative hemodynamic support on early outcome in patients assisted with paracorporeal Thoratec® ventricular assist device

The Importance of Reverse Translation for Preclinical Off-Target Mitigation: Quantification and Mitigation of Biases in the FDA Adverse Event Reporting System

Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria

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