Long-term dobutamine therapy for refractory congestive heart failure

The proposed benefit of long-term dobutamine therapy is explained, relevant clinical trials are described, and recommendations for this treatment are discussed. Dobutamine increases cardiac contractility and causes vasodilation with little change in heart rate. It is routinely administered for short periods to relieve exacerbations of congestive heart failure (CHF) in hospitalized patients. Sustained effects have been seen with dobutamine infusions, although the known properties of the drug do not explain these effects. Long-term dobutamine therapy can lessen the symptoms of CHF and improve exercise tolerance and cardiac function. Nine published reports showed consistent improvement in 77 patients treated with multiple infusions of dobutamine. At Ohio State University, long-term dobutamine therapy (typically 5.0-7.5 micrograms/kg/min infused continuously) is used in patients with refractory CHF and those awaiting heart transplantation. Because the therapy does not prolong survival in most patients, specific endpoints of therapy should be determined for each patient. Because it may cause sudden death, patients receiving this therapy must be carefully monitored. Long-term use of dobutamine infusion lessens the symptoms of CHF but does not prolong survival.