title: Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure.
abstract: BACKGROUND
  There are no published clinical trials comparing dobutamine with milrinone in outpatients with stage D heart failure on continuous inotropes.
  
  
  RESULTS
  In a retrospective analysis of 112 inotrope-dependent patients with stage D heart failure who were not transplant candidates at enrollment, we investigated the relationship between choice of dobutamine or milrinone and mortality. Half the patients were on dobutamine (mean dose, 5.4+/-2.5 microg/kg per minute) and half on milrinone (mean dose, 0.4+/-0.2 microg/kg per minute). Those on dobutamine tended to be older (63 years old versus 54 years old), male (86% versus 79%), and fewer had implantable cardioverter-defibrillators (57% versus 74%). During a median follow-up time of 130 days (range, 2 to 2345 days), there were 85 deaths (76% of cohort) and 55 rehospitalizations. Use of dobutamine compared with milrinone was associated with higher all-cause mortality in an unadjusted analysis (hazard ratio [HR], 1.63; 95% CI, 1.06 to 2.52; P<0.03). However, this association was not significant after adjustment for baseline characteristics in the full cohort (N=112; HR, 0.99; 95% CI 0.5 to 1.97; P=0.98) or propensity-matched cohort (N=70; HR, 0.94; 95% CI 0.48 to 1.85; P=0.86).
  
  
  CONCLUSIONS
  In this single-center retrospective study, there were no mortality differences between chronic intravenous dobutamine or milrinone in patients with stage D heart failure being discharged from the hospital. The high mortality in this group selected for inotrope dependence warrants careful consideration of all options and priorities for further care.
authors.affiliation: Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
authors.forename: Eric C
authors.initials: EC
authors.lastname: Chu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Reese
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
authors.forename: Eileen
authors.initials: E
authors.lastname: Hsich
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone