Outpatient dobutamine and dopamine infusions in the management of chronic heart failure: Clinical experience in 21 patients

Applefeld, Mark M.; Newman, Kathryn A.; Sutton, Frederick J.; Reed, William P.; Roffman, David S.; Talesnick, Barry S.; Grove, William R.

doi:10.1016/0002-8703(87)90757-5

Cited by 74 publications

(32 citation statements)

References 21 publications

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“…(435,436), long-term oral therapy with these drugs has not improved symptoms or clinical status (292,(437)(438)(439)(440)(441)(442)(443)(444)(445)(446)(447) and has been associated with a significant increase in mortality, especially in patients with advanced HF (445,(448)(449)(450)(451)(452)(453). Despite these data, some physicians have proposed that the regularly scheduled intermittent use of intravenous positive inotropic drugs (e.g., dobutamine or milrinone) in a supervised outpatient setting might be associated with some clinical benefits (41)(42)(43)454).…”

Section: Drugs and Interventions Under Active Investigationmentioning

confidence: 99%

“…Nearly all of the available data are derived from open-label and uncontrolled studies or from trials that have compared one inotropic agent with another, without a placebo group (41)(42)(43)454). Most trials have been small and short in duration and thus have not been able to provide reliable information about the effect of treatment on the risk of serious cardiac events.…”

Section: Drugs and Interventions Under Active Investigationmentioning

confidence: 99%

See 1 more Smart Citation

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Hunt

Abraham

Chin³

et al. 2005

Circulation

1,971

773

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Section: Drugs and Interventions Under Active Investigationmentioning

confidence: 99%

Section: Drugs and Interventions Under Active Investigationmentioning

confidence: 99%

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Hunt

Abraham

Chin³

et al. 2005

Circulation

1,971

773

View full text Add to dashboard Cite

“…1 Several studies in the adult population have shown this therapy to potentially be harmful to patients with worse outcomes while on inotropic therapy compared with no intravenous inotrope use. [2][3][4] The pediatric HF population uses this therapy as a bridge to transplantation, in part because of the limited availability of ventricular assist devices (VADs) in children. 5 Although many patients on inotropic therapy are clinically unstable, a subset of this population may safely await transplantation at home.…”

mentioning

confidence: 99%

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

Birnbaum

Simpson

Boschert

et al. 2015

Circ: Heart Failure

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Background-Intravenous inotropic therapy can be used to support children awaiting heart transplantation. Although use of this therapy is discouraged in adults because of poor outcomes, its use in children, particularly outpatient, has had limited evaluation. We aimed to evaluate the safety and efficacy of this practice. Methods and Results-A retrospective analysis of an intent to treat protocol was completed on United Network for Organ Sharing status 1A patients discharged on inotropic therapy from 1999 until 2012. Intravenous inotropic therapy was initiated for cardiac symptoms not amenable to oral therapy. Patients who were not status 1A or required >1 inotrope were excluded. Efficacy was analyzed by time to first event: transplantation; readmission until transplantation; improvement leading to inotrope withdrawal; or death. Safety included analysis of infection rates, line malfunctions, temporary hospitalization, neurological events, and arrhythmias. One hundred six patients met inclusion criteria. The mean age was 10.1±6.4 years, 47% of patients had congenital heart disease, and 80% of these patients had single ventricle physiology.In patients without congenital heart disease, 53% had dilated cardiomyopathy, 91% of patients received milrinone, 85% of patients underwent transplantation, 8% of patients successfully weaned from support as outpatients, whereas 6% died. Fifty percent of patients were readmitted before transplantation or weaning from support, of which 64% required only 1 readmission. The majority of readmissions were for heart failure. Conclusions-Outpatient intravenous inotropic therapy can be safely used as a bridge to transplantation in pediatric patients.A minority of patients can discontinue inotropic therapy because of clinical improvement. (Circ Heart Fail. 2015;8:64-70.

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“…Changes in DA receptor number and/or properties could also occur, though there has been little convincing evidence to suggest an alteration in DA receptors [10], or endogenous renal DA formation in CCF [12]. Though studies in young patients with CCF did show a significant increase in ERPF with renal dose DA, these studies used higher but sub-inotropic doses of DA [5,7] or dobutamine [6]. This may explain improvements seen in other studies but not in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…This has prompted its therapeutic use in young patients with intractable CCF [5,6,7]; in addition to its acute benefit, one study showed a sustained benefit for up to 28 months [6].…”

Section: Introductionmentioning

confidence: 99%

The acute effects of a single dopamine infusion in elderly patients with congestive cardiac failure.

Robinson

Gariballa

Fancourt

et al. 1994

Brit J Clinical Pharma

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1. Dopamine (DA) at low doses (2.5 micrograms kg‐1 min‐1) produces a measurable increase in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) in young healthy subjects and has a therapeutic effect in younger patients with congestive cardiac failure (CCF). In elderly healthy subjects, DA increases ERPF but does not increase GFR in all subjects. 2. To determine the potential therapeutic use of DA in elderly subjects with CCF, we studied 17 patients (5 male) aged 79.9 years (range 68 to 93 years) admitted to hospital for inpatient treatment of CCF resistant to diuretic and angiotensin converting enzyme inhibitor therapy. The effects of a single infusion DA at 2.5 micrograms kg‐1 min‐1 on GFR and ERPF were assessed in a double‐blind, placebo controlled prospective study. 3. There were no significant differences in GFR or ERPF between control and DA. A reduction in GFR was seen in some patients. 4. DA at low dosage was not shown to benefit elderly patients with resistant CCF, and in some patients was detrimental. Higher doses or a combination with other inotropes may be necessary for a renal effect in elderly patients.

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Outpatient dobutamine and dopamine infusions in the management of chronic heart failure: Clinical experience in 21 patients

Cited by 74 publications

References 21 publications

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Intravenous Home Inotropic Use Is Safe in Pediatric Patients Awaiting Transplantation

The acute effects of a single dopamine infusion in elderly patients with congestive cardiac failure.

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