Amiodarone rescue therapy for severe decompensated heart failure initially unsuitable for beta-blockers

Beta-blocker therapy is now standard therapy for patients with stable heart failure; however, fluid-overloaded, New York Heart Association Class IV patients tolerate beta-blockers poorly. Amiodarone, a drug with antiadrenergic effects, has been shown to improve survival for patients with heart rates of 90 beats per minute or greater.

We reviewed 26 patients with severe decompensated heart failure who were started on oral amiodarone for heart rate control. beta-Blocker titration was attempted when patients became clinically stable.

The mean age of the patients was 48.5 +/- 17.5 years, and 73% were male. Fifteen patients were New York Heart Association Class IV, and 11 were Class III. Of these, 23 (88%) were fluid-overloaded, and 11 (42%) were on inotropic agents when amiodarone was started. The mean ejection fraction was 16.1 +/- 6%. The initial dose of amiodarone was 346 +/- 120 mg/day. Twenty (77%) patients were successfully started on beta-blockers. At follow-up prior to beta-blockers, 20 (77%) patients improved by at least one New York Heart Association class. Heart rate decreased from a mean of 98 +/- 15 to 78 +/- 13 beats per minute (P <.0001). Echocardiograms were available in 12 patients, with ejection fractions increasing from 16.1 +/- 8% to 26.8 +/- 13% (P =.004).

Amiodarone may be an effective rescue therapy for patients with decompensated heart failure and serve as a bridge to subsequent beta-blocker therapy.