Effect of Inpatient Dobutamine vs. Milrinone on Out-of-Hospital Mortality in Patients with Acute Decompensated Heart Failure.
Pharmacotherapy. 2017 May 05;:
Authors: King JB, Shah RU, Sainski-Nguyen A, Biskupiak J, Munger MA, Bress AP
Abstract
STUDY OBJECTIVE: To determine the effect of dobutamine versus milrinone on out-of-hospital mortality in treatment of patients with acute decompensated heart failure (ADHF).
DESIGN: Propensity score weighted, retrospective cohort study with mortality as primary outcome.
SETTING: An academic health-care system.
PATIENTS: 500 adult patients with a prior history of heart failure, who survived a hospitalization for ADHF that included treatment with dobutamine or milrinone between January 1, 2006 and April 30, 2014.
MEASUREMENTS AND MAIN RESULTS: ADHF events were defined as a hospitalization with receipt of an intravenous loop diuretic or a Brain-type natriuretic peptide (BNP) value greater than 400 pg/mL during the hospitalization. Patients were followed until death or 180 days from hospital discharge. Risk ratios (RR) for mortality associated with dobutamine compared to milrinone were calculated at 15, 30, and 180 days post-discharge using Poisson regression with robust error variance. Mean age was 62.7 years, 65.4% were male, and 48.2% had a mean left ventricular ejection fraction (LVEF) 40% or lower. Overall, 55 (18%) of dobutamine-treated versus 23 (12%) of milrinone-treated patients died during follow-up (RR, 1.27; 95% CI, 0.76-2.13; p=0.360). For death from cardiovascular causes the RR for dobutamine was 1.49 (95% CI, 0.79-2.82, p=0.214). For death from worsening heart failure the RR for dobutamine was 2.55 (95% CI, 1.07-6.10, p=0.035). A trend towards significance was observed at 15-days post-discharge for all mortality analyses (all p-values <0.10).
CONCLUSIONS: Dobutamine was associated with higher short-term, out-of-hospital mortality compared with milrinone in patients with ADHF. These results replicate and extend prior associations with mortality and should be confirmed in a prospective study. This article is protected by copyright. All rights reserved.
PMID: 28475215 [PubMed - as supplied by publisher]