Treatment of severe heart failure: quantity or quality of life? A trial of enoximone. Enoximone Investigators.

Cowley, Alison; Skene, Allan M.

doi:10.1136/hrt.72.3.226

Cited by 117 publications

(52 citation statements)

References 8 publications

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“…However, drugs such as milrinone, enoximone, and flosequinan have been shown to improve symptoms at the expense of an increase in fatality. [1][2][3] Thus, evidence that a new drug improves the symptoms of heart failure is necessary but not sufficient for its acceptance into clinical use. Ideally, a new drug would increase survival and improve symptoms; at the least, it should have no effect on survival.…”

Section: Introductionmentioning

confidence: 99%

Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure

et al. 1997

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Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure Hampton, J.R.; Veldhuisen, D.J.; Kleber, F.X.; Cowley, A.J.; Ardia, A.; Block, P.; Cortina, A.; Cserhalmi, L.; Follath, F.; Jensen, G.; Kayanakis, J.; Lie, K.I.; Mancia, G.; Skene, A.M. Published in: Lancet DOI:10.1016/S0140-6736(96)10488-8 Link to publicationCitation for published version (APA): Hampton, J. R., Veldhuisen, D. J., Kleber, F. X., Cowley, A. J., Ardia, A., Block, P., ... Skene, A. M. (1997). Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet, 349, 971-977. https://doi.org/10.1016/S0140-6736(96)10488-8 General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 22 Mar 2019Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure J R Hampton, D J van Veldhuisen, F X Kleber, A J Cowley, A Ardia, P Block, A Cortina, L Cserhalmi, F Follath, G Jensen, J Kayanakis, K I Lie, G Mancia, A M Skene, for the Second Prospective Randomised Study of Ibopamine on Mortality and Efficacy (PRIME II) Investigators THE LANCET SummaryBackground Drugs that improve symptoms in patients with heart failure must also be assessed for their effects on survival. Ibopamine stimulates DA-1 and DA-2 receptors and causes peripheral and renal vasodilatation; the drug improves symptoms of heart failure. W e assessed the effect of ibopamine on survival in patients with advanced heart failure in a mult ic ent re, randomised plac ebocontrolled study.

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Section: Introductionmentioning

confidence: 99%

Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure

et al. 1997

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“…2 Increasing evidence indicates that routine administration of inotropic agents may heighten mortality risk in patients with ADHF. [3][4][5][6][7][8][9][10][11][12] Consequently, the European Society of Cardiology recommends that inotropic agents be prescribed only for patients with peripheral hypoperfusion with or without congestion or pulmonary edema that is refractory to diuretics and vasodilators at optimum dosages. 1 Despite concerns regarding inotropics, these agents remain a common therapeutic strategy and are prescribed for about 11% of hospitalized patients.…”

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Outcomes Associated with Vasoactive Therapy in Patients with Acute Decompensated Heart Failure

et al. 2006

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Study Objectives. To describe the clinical management of acute decompensated heart failure (ADHF) in patients receiving intravenous treatment with dobutamine, milrinone, or nesiritide, and to evaluate differences, based on treatment received, in the in-hospital mortality rate, length of stay (LOS), total health care costs, and 30-day hospital readmission rate. according to the vasoactive therapy received. To evaluate baseline characteristics, 2 analysis was used; logistic regression was employed to assess the relationships between drug therapy and in-hospital mortality rates, and multivariate linear regression was used to assess whether drug therapy was related to LOS and total health care costs. All regression analyses controlled for age, sex, race, region of the United States where the hospital was located, primary payer for the hospital stay, UHC patient severity class, and chronic renal failure. In-hospital mortality rates were 10.2%, 7.9%, and 2.9% in the dobutamine, milrinone, and nesiritide groups, respectively. This resulted in an adjusted odds ratio for death of 3.5 (95% confidence interval [CI] 1.8-6.8) for dobutamine and 3.9 (95% CI 1.8-8.3) for milrinone (p<0.0001). Compared with inotropic therapy (dobutamine and milrinone), mean LOS in the hospital and the intensive care unit were lower with nesiritide (p<0.001). Total health care costs were lowest with nesiritide, but this reached statistical significance only when compared with milrinone (p<0.001). Thirty-day hospital readmission rates with dobutamine, milrinone, and nesiritide were 5.0%, 9.5%, and 3.9%, respectively (p=NS). Conclusion. Nesiritide therapy was associated with a lower in-hospital mortality rate and shorter LOS compared with dobutamine and milrinone. In addition, total health care costs with nesiritide were decreased compared with milrinone. These observations need to be validated by a randomized controlled trial.

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“…Limitations of oral inotropic treatment: Although several intravenous and oral inotropic agents have been developed to treat advanced heart failure, most of them have been shown to increase mortality. [33][34][35] The precise mechanisms by which longterm treatment with either intravenous or oral inotropic agents increase the mortality rate in patients with chronic heart failure remain unknown. The increase in the intracellular cyclic AMP induced by these drugs may be directly toxic to injured myocardial cells and enhance the electrophysiological derangement, which is supported by the development of rhythm disturbance in experimental studies.…”

Section: Figurementioning

confidence: 99%

Efficacy and Limitations of Oral Inotropic Agents for the Treatment of Chronic Heart Failure

et al. 2013

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SummaryThe heart failure guideline in Japan has stated the necessity of investigating the role of oral inotropic agents in patients with chronic heart failure (CHF), which are clinically available only in Japan. A total of 1,846 consecutive patients with heart failure (mean: 69.5 years old, 1,279 males) treated at our institute from November 2009 to August 2010 were investigated retrospectively. Thirty-one patients (1.84%) who had taken oral inotropic agents (pimobendan 27, docarpamine 6, and denopamine 4) were extracted for this study, and the efficacy and limitations of the treatments were analyzed. Following the oral inotropic treatment, the NYHA functional class (P = 0.017), cardiothoracic ratio (P = 0.002) and B-type natriuretic peptide levels (P = 0.011) were significantly improved, and the number of emergency room (ER) visits (P < 0.001) and hospitalizations (P < 0.001) were significantly reduced. The nonsurviving patients (n = 7/31, 22.6%) were significantly older (P = 0.02) and tended to have a larger cardiothoracic ratio (P = 0.084) compared with the survivors. An absence of concomitant beta-blocker therapy was significantly associated with a worse prognosis (oneyear mortality 2/21 versus 5/10, log rank, P = 0.011). Oral inotropic agents brought about improvements in the clinical parameters of CHF and a reduction in ER visits and hospitalizations. However, concomitant beta-blocker therapy should be considered for patients receiving oral inotropic treatment. (Int Heart J 2013; 54: 75-81) Key words: Pimobendan, Denopamine, Docarpamine, Beta-blocker A lthough several oral inotropic agents have been developed for the treatment of advanced heart failure, such as oral catecholamines, phosphodiesterase III (PDE III) inhibitors, and Ca-sensitizers, [1][2][3][4][5] there have been no reports showing improvement in the patient survival for these treatments. On the other hand, beta-blocker therapy, [6][7][8] which is pharmacologically active in an opposite site to the inotropic agents, has brought about not only improvement in the longterm outcomes, but also improvement in cardiac function in patients with chronic heart failure (CHF). However, many patients with advanced heart failure have difficulty being weaned from intravenous inotropic therapy or recovering from their low output condition. There are few countries where oral inotropic agents are available for such instances. In Japan, a few oral inotropic agents, including pimobendan, denopamine, and docarpamine, are clinically available for inotropic treatment in patients with advanced heart failure 1,5) or as supportive treatment for beta-blocker therapy.9) The guidelines for the treatment of chronic heart failure from the Japanese Circulation Society have pointed out the necessity for clinical investigations concerning the efficacy and limitation of the oral inotropic treatments, which are available only in Japan, and are not approved in Western countries. Thus, the present study analyzed the real-world use, efficacy, and limitations of oral inotropic ag...

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Treatment of severe heart failure: quantity or quality of life? A trial of enoximone. Enoximone Investigators.

Abstract: Objectives-To determine the effects of enoximone on mortality and quality of life in patients with severe end stage heart failure. Design-A randomised, double blind, placebo controlled trial of the addition of enoximone to conventional treatment.

Cited by 117 publications

References 8 publications

Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure

Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure

Outcomes Associated with Vasoactive Therapy in Patients with Acute Decompensated Heart Failure

Efficacy and Limitations of Oral Inotropic Agents for the Treatment of Chronic Heart Failure

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