Outpatient dobutamine for end-stage congestive heart failure

Eleven patients with refractory class IV congestive heart failure who were not candidates for cardiac transplantation were given iv dobutamine therapy on an outpatient basis. All patients underwent hemodynamic evaluation to confirm a beneficial response to low dose (5 micrograms/kg.min) dobutamine and to establish arrhythmia control both on and off dobutamine before hospital discharge. Six of the 11 patients could not be weaned from dobutamine in hospital and were discharged on continuous infusion (maximum dose, 5 micrograms/kg.min), while four were discharged with an infusion regimen ranging from 3 to 5 consecutive days/wk. All patients had a chronic venous access placed and were instructed on the use of an external battery-powered infusion pump with a container holding a concentrated solution of dobutamine hydrochloride. All infusions were delivered at home on an ambulatory basis. Intravenous drug support was discontinued gradually over an average of 3.2 months; seven of 11 patients were able to be weaned entirely from iv inotropic therapy and were maintained on oral therapy alone. Seven of the 11 patients (six of whom were maintained on oral therapy alone) required no hospital readmission during the infusion or follow-up period.