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Clinical trials update: OPTIME-CHF, PRAISE-2, ALL-HAT.
S Thackray1, K Witte, A L Clark
1Department of Cardiology, Academic Unit, Castle Hill Hospital, Castle Road, HU16 5JQ, Kingston upon Hull, UK.
European Journal of Heart Failure
|June 17, 2000
Summary
Intravenous Milrinone did not improve outcomes for acute exacerbations of chronic heart failure. The study found no significant differences in hospital stay or readmissions, but did note increased hypotension with Milrinone.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic heart failure (CHF) exacerbations require effective treatments.
- Intravenous inotropic agents are sometimes used, but their efficacy and safety in CHF are debated.
Purpose of the Study:
- To evaluate the efficacy and safety of a 48-hour intravenous Milrinone infusion compared to standard therapy for acute exacerbations of chronic heart failure.
Main Methods:
- A randomized-controlled trial (OPTIME-CHF) involving 951 patients with acute exacerbations of CHF.
- Patients received either a 48-hour infusion of Milrinone or placebo.
- Exclusion criteria included conditions mandating inotropic therapy.
Main Results:
- No significant differences were observed in length of hospital stay, 60-day readmissions, or hospital days over 60 days.
- Subjective clinical assessment scores and 1-year readmission rates were similar between groups.
- A significant increase in sustained hypotension was observed in the Milrinone group.
Conclusions:
- Intravenous Milrinone does not offer benefit for acute exacerbations of chronic heart failure.
- Previous trials also indicated a lack of benefit for oral Milrinone in stable or severe CHF.
- The role of Milrinone in managing hemodynamic crises requiring inotropic support warrants further questioning.