title: Effect of pimobendan in addition to standard therapy for heart failure on prevention of readmission in elderly patients with severe chronic heart failure.
abstract: OBJECTIVE
  We evaluated the effect of pimobendan, a positive inotropic agent, in elderly patients with frequent readmission as a result of heart failure despite conventional therapy.
  
  
  METHODS
  Pimobendan was given to five male patients with severe chronic heart failure (New York Heart Association class III-IV) (age range 69-89 years; mean 78 ± 8 years; ischemic cardiomyopathy in three cases, dilated cardiomyopathy in two cases) who required repeated admission for heart failure despite conventional therapy with angiotensin inhibitors, beta-blockers, diuretics and anti-arrhythmic agents. After the addition of pimobendan at a dose of 1.25-3.75 mg/day, we evaluated serum levels of brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), septal e' and left ventricular end-diastolic diameter (LVDD) by echocardiography, as well as readmission rates for more than 2 years.
  
  
  RESULTS
  The serum level of BNP significantly decreased after treatment with pimobendan, although its level returned to pretreatment levels after 2 years. LVEF significantly improved after the treatment, with the improvement continuing beyond the 2 years, although LVDD did not change after treatment. Septal e' significantly improved after the treatment, although its level returned to pretreatment levels at 2 years after the treatment. Readmission rates significantly decreased for 2 years after the treatment, although one patient required cardiac resynchronization therapy for severe heart failure, and another patient required cardiac pacemaker implantation for sick sinus syndrome 2 years after adding pimobendan.
  
  
  CONCLUSIONS
  Pimobendan in conjunction with conventional therapy for heart failure decreases the readmission rate in elderly patients with severe heart failure for at least 2 years.
authors.affiliation: Department of Cardiology, Nagasaki Rosai Hospital, Sasebo, Japan; Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawano
authors.forename: Shuji
authors.initials: S
authors.lastname: Arakawa
authors.forename: Osami
authors.initials: O
authors.lastname: Satoh
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Motonobu
authors.initials: M
authors.lastname: Hayano
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakatomi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamasa
authors.forename: Koji
authors.initials: K
authors.lastname: Maemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000008:administration & dosage; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011724:Pyridazines / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; C041648:pimobendan
keywords: calcium sensitizer; cyclic adenosine monophosphate; heart failure; inotropic agent; treatment