title: Intravenous milrinone in treatment of advanced congestive heart failure.
abstract: Phosphodiesterase inhibitors such as milrinone can relieve symptoms and improve hemodynamics in patients with advanced congestive heart failure. We retrospectively evaluated the hemodynamic and clinical outcomes of long-term combination therapy with intravenous milrinone and oral beta-blockers in 65 patients with severe congestive heart failure (New York Heart Association class IV function and ejection fraction <25%) refractory to oral medical therapy. Fifty-one patients successfully began beta-blocker therapy while on intravenous milrinone. Oral medical therapy was maximized when possible. The mean duration of milrinone treatment in this combination-treatment group was 269 days (range, 14-1,026 days). Functional class improved from IV to II-III with milrinone therapy. Twenty-four such patients tolerated beta-blocker up-titration and were successfully weaned from milrinone. Sixteen patients (31%) died while receiving combination therapy; one died of sudden cardiac death (on treatment day 116); the other 15 died of progressive heart failure or other complications. Hospital admissions during the previous 6 months and admissions within 6 months after milrinone initiation stayed the same. Meanwhile, the total number of hospital days decreased from 450 to 380 (a 15.6% reduction), and the mean length of stay decreased by 1.4 days (a 14.7% reduction). We conclude that 1) milrinone plus beta-blocker combination therapy is an effective treatment for heart failure even with beta-blocker up-titration, 2) weaning from milrinone may be possible once medications are maximized, 3) patients' functional status improves on the combination regimen, and 4) treatment-related sudden death is relatively infrequent during the combination regimen.
authors.affiliation: Departments of Transplantation and Heart Failure, Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
authors.forename: Aly M
authors.initials: AM
authors.lastname: Zewail
authors.forename: Mohammad
authors.initials: M
authors.lastname: Nawar
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: Cathy
authors.initials: C
authors.lastname: Eastwood
authors.forename: M N Biswajit
authors.initials: MN
authors.lastname: Kar
authors.forename: Reynolds M
authors.initials: RM
authors.lastname: Delgado
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D010726:Phosphodiesterase Inhibitors; D020105:Milrinone