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Long-term intermittent dobutamine infusion, combined with oral amiodarone for end-stage heart failure: a randomized
John N Nanas1, Eleftheria P Tsagalou, John Kanakakis
1University of Athens School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece. jnanas@ath.forthnet.gr
Insights
This study found that intermittent dobutamine infusions combined with amiodarone significantly improved survival in advanced congestive heart failure patients. This combination therapy offers a promising option for refractory heart failure cases.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Congestive heart failure (CHF) poses a significant mortality risk, especially in advanced stages refractory to standard treatments.
- Current therapeutic options for end-stage CHF are limited, necessitating novel treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of long-term intermittent dobutamine infusion combined with oral amiodarone in patients with advanced CHF.
- To assess the impact of this combination therapy on survival rates and functional status.
Main Methods:
- A prospective, randomized, double-blind, placebo-controlled trial was conducted.
- Thirty patients with end-stage CHF received either intermittent dobutamine infusions (10 micro g/kg/min for 8h every 14 days) or placebo, alongside oral amiodarone and standard medical therapy.
- Kaplan-Meier survival analysis was used to compare outcomes between the groups.
Main Results:
- The dobutamine and amiodarone combination group showed a 60% reduction in the risk of death compared to placebo (HR, 0.403; p = 0.048).
- One-year and two-year survival rates were significantly higher in the dobutamine group (69% and 44%) versus the placebo group (28% and 21%).
- Median survival was substantially longer in the dobutamine group (574 days vs. 144 days).
Conclusions:
- Long-term intermittent dobutamine infusion, when combined with amiodarone and conventional therapy, significantly improves survival in patients with advanced, refractory congestive heart failure.
- This combination therapy represents a viable strategy for enhancing outcomes in severe heart failure patients.
Study Objectives:
To examine the effects of long-term intermittent dobutamine infusion, combined with oral amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment.
Design:
Prospective, randomized, double-blind, placebo-controlled clinical trial.
Setting:
Inpatient and outpatient heart failure clinic in a university teaching hospital.
Patients And Interventions:
Thirty patients with end-stage CHF refractory to standard medical treatment who could be weaned from dobutamine therapy after a first 72-h infusion were randomized in a double-blind manner to receive IV infusions of placebo (group 1; 14 patients) vs dobutamine in a dose of 10 micro g/kg/min (group 2; 16 patients) for 8 h every 14 days. All patients received standard medical therapy and also were treated with oral amiodarone, 400 mg/d, which was started at least 2 weeks before randomization.
Measurements And Results:
Kaplan-Meier survival analysis showed a 60% reduction in the risk of death from any cause in the group treated with the combination of dobutamine and amiodarone, compared with the group treated with placebo and amiodarone (hazard ratio, 0.403; 95% confidence interval, 0.164 to 0.992; p = 0.048). The 1-year and 2-year survival rates were 69% and 44%, respectively, in the dobutamine-treated group, vs 28% and 21%, respectively, in the placebo-treated group (p < 0.05 for both comparisons). Median survival times were 574 and 144 days, respectively, for groups 2 and 1. At 6 months, the New York Heart Association functional class was significantly improved in the patients who survived from both groups.
Conclusions:
Long-term intermittent dobutamine infusion combined with amiodarone added to the conventional drugs improved the survival of patients with advanced CHF that was refractory to conventional treatment.
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