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Original Articles

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

Eiran Z. Gorodeski, MD, MPH; Eric C. Chu, BS; Jennifer R. Reese, BSN, RN; Mehdi H. Shishehbor, DO, MPH; Eileen Hsich, MD and Randall C. Starling, MD, MPH

From the Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Correspondence to Randall C. Starling, MD, MPH, Cleveland Clinic, Heart and Vascular Institute, 9500 Euclid Ave, Cleveland, OH 44195. E-mail starlir{at}ccf.org

Received November 26, 2008; accepted April 23, 2009.

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 a retrospective analysis of 112 inotrope-dependent patients with stage D heart failure who were not transplant candidates at enrollment, we investigated the relationship between choice of dobutamine or milrinone and mortality. Half the patients were on dobutamine (mean dose, 5.4±2.5 µg/kg per minute) and half on milrinone (mean dose, 0.4±0.2 µg/kg per minute). Those on dobutamine tended to be older (63 years old versus 54 years old), male (86% versus 79%), and fewer had implantable cardioverter-defibrillators (57% versus 74%). During a median follow-up time of 130 days (range, 2 to 2345 days), there were 85 deaths (76% of cohort) and 55 rehospitalizations. Use of dobutamine compared with milrinone was associated with higher all-cause mortality in an unadjusted analysis (hazard ratio [HR], 1.63; 95% CI, 1.06 to 2.52; P<0.03). However, this association was not significant after adjustment for baseline characteristics in the full cohort (N=112; HR, 0.99; 95% CI 0.5 to 1.97; P=0.98) or propensity-matched cohort (N=70; HR, 0.94; 95% CI 0.48 to 1.85; P=0.86).

Conclusions— In this single-center retrospective study, there were no mortality differences between chronic intravenous dobutamine or milrinone in patients with stage D heart failure being discharged from the hospital. The high mortality in this group selected for inotrope dependence warrants careful consideration of all options and priorities for further care.

Key Words: heart failure • inotropic agents • mortality

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CLINICAL PERSPECTIVE