Repetitive milrinone therapy in ambulatory advanced heart failure patients

Background: Advanced heart failure (HF) patients usually poorly tolerate guideline directed HF medical therapy (GDMT) and suffer high rates of morbidity and mortality. The use of continuous inotropes in the outpatient settings is hampered by previous data showing excess mortality. We aimed to assess the safety and efficacy of repetitive, intermittent, short-term intravenous milrinone therapy in advanced HF patients with an intention to introduce and up titrate GDMT.

Methods: Advanced HF patients treated with beta-blockers and implanted with defibrillators were initiated with repetitive, intermittent short-term intravenous milrinone therapy at our HF outpatient clinic and prospectively followed with defibrillator interrogation, B-natriuretic peptide (BNP) levels and echocardiography.

Results: The cohort included 24 patients with a mean 250±216 days of milrinone therapy exposure. Mean age was 73±6 years with male predominance (96%). Following milrinone therapy, mean BNP levels decreased (1543±1679PG/ML to 1202±1213PGML), left ventricular dimensions stabilized, the number of total HF hospitalizations decreased (28 to 19) and the number of patients on GDMT increased. Importantly, the number of total sustained ventricular tachycardia events did not change (6 vs 4 events before and after milrinone exposure, respectively).

Conclusion: In this small cohort of advanced HF, repetitive, intermittent, short-term milrinoe therapy was found to be safe and potentially efficacious.