Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST).
OBJECTIVE
To evaluate clinical characteristics and outcomes of patients with advanced heart failure receiving intravenous continuous dobutamine in the FIRST Trial (Flolan International Randomized Survival Trial).


METHODS
Four hundred seventy-one patients with class IIIb to IV heart failure who were enrolled in the FIRST trial were included. Eighty patients treated with dobutamine at FIRST randomization were compared with 391 patients not treated with dobutamine at randomization. The occurrence of worsening heart failure, need for vasoactive medications, resuscitated cardiac arrest, myocardial infarction, and total mortality were compared between the 2 groups.


RESULTS
The dobutamine group had a higher occurrence of first event (85.3% vs 64. 5%; P =.0006) and a higher mortality rate (70.5% vs 37.1%; P =.0001) compared with the no dobutamine group. Intravenous continuous dobutamine was an independent risk factor for death after adjusting for baseline differences.


CONCLUSIONS
Dobutamine use at the time of randomization was associated with a higher 6-month mortality rate. This effect persisted after adjustment for baseline differences. This analysis challenges the concept that continuous intravenous dobutamine is beneficial to advanced heart failure patients with respect to survival.
O'Connor
C M
CM
Duke University Medical Center, Durham, NC 27710, USA. oconn002@mc.duke.edu
Gattis
W A
WA
Uretsky
B F
BF
Adams
K F
KF
McNulty
S E
SE
Grossman
S H
SH
McKenna
W J
WJ
Zannad
F
F
Swedberg
K
K
Gheorghiade
M
M
Califf
R M
RM
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D004280:Dobutamine