Published Online
on May 14, 2009

A more recent version of this article appeared on July 1, 2009

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Original Article

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

Eiran Z. Gorodeski; Eric C. Chu; Jennifer R. Reese; Mehdi H. Shishehbor; Eileen Hsich and Randall C. Starling¹

Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH

¹ E-mail: starlir{at}ccf.org

Background—There are no published clinical trials comparing dobutamine to milrinone in outpatients with Stage D heart failure (HF) on continuous inotropes.

Methods and Results—In a retrospective analysis of 112 inotrope-dependent Stage D HF patients who were not transplant candidates at enrollment, we investigated the relationship between choice of dobutamine or milrinone and mortality. Half of the patients were on dobutamine (mean dose 5.4±2.5 mcg/kg/min) and half on milrinone (mean dose 0.4±0.2 mcg/kg/min). Those on dobutamine tended to be older (63 vs. 54 years old), male (86% vs. 79%), and fewer had ICDs (57% vs. 74%). During a median follow-up time of 130 days (range 2 to 2345 days), there were 85 deaths (76% of cohort) and 55 re-hospitalizations. Use of dobutamine as compared to milrinone was associated with higher all-cause mortality in an unadjusted analysis (HR 1.63; 95% CI 1.06 to 2.52; P<.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=.98) or propensity matched cohort (N=70, HR 0.94; 95% CI 0.48 to 1.85; P=.86).

Conclusions—In this single center retrospective study there were no mortality differences between chronic intravenous dobutamine or milrinone in patients with Stage D HF 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