Repetitive milrinone therapy in ambulatory advanced heart failure patients.
advanced heart failure
inotropes
milrinone
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
revised:
13
02
2022
received:
22
10
2021
accepted:
15
02
2022
pubmed:
5
3
2022
medline:
29
4
2022
entrez:
4
3
2022
Statut:
ppublish
Résumé
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 morbidity. 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 and improve functional class. Repetitive, intermittent milrinone therapy may assist with the stabilization of advanced HF patients. 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 unit. Patients were prospectively followed with defibrillator interrogation, functional class assessment, B-natriuretic peptide (BNP) levels, and echocardiography parameters. The cohort included 24 patients with a mean 330 ± 240 days of milrinone therapy exposure. Mean age was 73 ± 6 years with male predominance (96%). Following milrinone therapy, median BNP levels decreased significantly (882 [286-3768] to 631 [278-1378] pg/ml, p = .017) with a significant reduction in the number of patients with New York Heart Association (NYHA) Class III and IV (p = .012, 0.013) and an increase in number of patients on GDMT. Importantly, the number of total sustained ventricular tachycardia events and HF hospitalizations did not change. In this small cohort of advanced HF, repetitive, intermittent, short-term milrinone therapy was found to be safe and potentially efficacious.
Sections du résumé
BACKGROUND
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 morbidity. 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 and improve functional class.
HYPOTHESIS
OBJECTIVE
Repetitive, intermittent milrinone therapy may assist with the stabilization of advanced HF patients.
METHODS
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 unit. Patients were prospectively followed with defibrillator interrogation, functional class assessment, B-natriuretic peptide (BNP) levels, and echocardiography parameters.
RESULTS
RESULTS
The cohort included 24 patients with a mean 330 ± 240 days of milrinone therapy exposure. Mean age was 73 ± 6 years with male predominance (96%). Following milrinone therapy, median BNP levels decreased significantly (882 [286-3768] to 631 [278-1378] pg/ml, p = .017) with a significant reduction in the number of patients with New York Heart Association (NYHA) Class III and IV (p = .012, 0.013) and an increase in number of patients on GDMT. Importantly, the number of total sustained ventricular tachycardia events and HF hospitalizations did not change.
CONCLUSIONS
CONCLUSIONS
In this small cohort of advanced HF, repetitive, intermittent, short-term milrinone therapy was found to be safe and potentially efficacious.
Identifiants
pubmed: 35243658
doi: 10.1002/clc.23802
pmc: PMC9045071
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Cardiotonic Agents
0
Milrinone
JU9YAX04C7
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
488-494Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
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