title: Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Dobutamine is recommended for patients with severe heart failure; however uncertainty exists as to its effect on mortality. This study aims to critically review the literature to evaluate whether dobutamine, compared with placebo or standard care, is associated with lower mortality and a range of secondary outcomes, in patients with severe heart failure.
  
  
  METHODS
  A systematic review and meta-analysis of randomised controlled trials was performed. PubMed, EMBASE, the Cochrane Central Trials Registry, the metaRegister of Controlled Trials and bibliographies of retrieved articles were searched. Randomised trials comparing dobutamine with placebo or standard care, in human, adult patients with severe heart failure, were included if they reported at least one outcome of interest. Data regarding trial validity, methodological processes and clinical outcomes were extracted, and a meta-analysis was performed.
  
  
  RESULTS
  Fourteen studies, with 673 participants, met the inclusion criteria and were included; 13 studies reported mortality. There was minimal heterogeneity (I(2) = 4.5%). The estimate of the odds ratio for mortality for patients with severe heart failure treated with dobutamine compared with standard care or placebo was 1.47 (95% confidence interval 0.98-2.21, p = 0.06).
  
  
  CONCLUSIONS
  This meta-analysis showed that dobutamine is not associated with improved mortality in patients with heart failure, and there is a suggestion of increased mortality associated with its use, although this did not reach the conventional level of statistical significance. Further research to define the role of dobutamine in treatment of severe heart failure should be a priority.
authors.affiliation: Intensive Care Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia. ctacon@live.com.au
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Tacon
authors.forename: John
authors.initials: J
authors.lastname: McCaffrey
authors.forename: Anthony
authors.initials: A
authors.lastname: Delaney
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016206:Databases, Bibliographic; D004280:Dobutamine / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D009026:Mortality / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine