Comparison of dobutamine versus milrinone therapy in hospitalized patients awaiting cardiac transplantation: a prospective, randomized trial.
BACKGROUND
The use of dobutamine or milrinone for inotropic support in patients with heart failure awaiting cardiac transplantation is largely arbitrary and based on institutional preference. The costs and effectiveness of these drugs have yet to be compared in a prospective, randomized study.


METHODS
We compared clinical outcomes and costs associated with the use of dobutamine or milrinone in 36 hospitalized patients awaiting cardiac transplantation. Patients were randomly assigned to receive either dobutamine or milrinone at the time of initial hospitalization and were followed until death, transplantation, or placement of mechanical cardiac support (intra-aortic balloon pump or left ventricular assist device).


RESULTS
Seventeen patients were randomly assigned to receive dobutamine (mean dose 4.1 +/- 1.4 microg/kg/min) and 19 patients received milrinone (mean dose 0.39 +/- 1.0 microg/kg/min). Therapy lasted 50 +/- 46 days for those in the dobutamine group and 63 +/- 45 days in the milrinone group. We did not detect differences between the 2 groups in right heart hemodynamics, death, need for additional vasodilator/inotropic therapy, or need for mechanical cardiac support before transplantation. Ventricular arrhythmias requiring increased antiarrhythmic therapy occurred frequently in both groups. Total acquisition cost of milrinone was significantly higher than that of dobutamine (16,270 dollars +/- 1334 vs 380 dollars +/- 533 P <.00001).


CONCLUSIONS
Both dobutamine and milrinone can be used successfully as pharmacologic therapy for a bridge to heart transplantation. Despite similar clinical outcomes, treatment with milrinone incurs greater cost.
Aranda
Juan M
JM
University of Florida College of Medicine, Division of Cardiovascular Medicine, the University of Florida Shands Transplant Center, Gainesville, FL 32610-0395, USA. arandjm@mail-cs.med.ufl.edu
Schofield
Richard S
RS
Pauly
Daniel F
DF
Cleeton
Timothy S
TS
Walker
Tracy C
TC
Monroe
V Steven
VS
Leach
Dana
D
Lopez
Larry M
LM
Hill
James A
JA
D000318:Adrenergic beta-Agonists / Q000191:economics / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use*; D004280:Dobutamine / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000191:economics / Q000627:therapeutic use*; D011446:Prospective Studies; D013223:Statistics as Topic
D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone