Long-Term Use of Intravenous Inotropes in Ambulatory Heart Failure Patients – A Contemporary Study in 3,278 Patients

Background - recent studies have shown that the outcomes of advanced heart failure (HF) patients treated with long term inotropes are better than previously reported. Nevertheless, questions remain as to inotrope selection and whether it is appropriate and advantageous to continue HF disease modifying therapies. Here we compared the survival rates of patients treated with 2 of the most commonly used inotropes, dobutamine and milrinone, and examined the effect of continued β blocker therapy.

Methods and results – we used the database of a US national home infusion company to examine the outcomes of all advanced HF patients treated with dobutamine or milrinone with and without a β blocker therapy. Our cohort included 3,278 patients, mean age 60.8±16.1, 74% men, 2,444 (73.8%) treated with milrinone and 867 (26.2%) with dobutamine. β blocker therapy was applied in 804 (24.3%) of the patients. Adjusted 180-day survival rate was 78.6%. Survival rates were significantly better with the use of milrinone compared with dobutamine (HR=0.557, p < 0.001). Inclusion of a β blocker therapy significantly improved overall survival rates (HR=0.402, p = 0.016).

Conclusion – in a retrospective analysis of a large contemporary multicenter cohort of advanced HF patients on inotropic support, superior survival rates were seen with milrinone compared to dobutamine and the presence of β blocker therapy was shown to further improve survival rates.