Outpatient dobutamine for end-stage congestive heart failure
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L W Miller1, E J Merkle, V Herrmann
1Department of Medicine, St. Louis University Medical Center, MO.
Insights
Outpatient intravenous dobutamine therapy can help advanced heart failure patients. Many patients were weaned off infusions, improving their quality of life and reducing hospital readmissions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Refractory class IV congestive heart failure presents significant treatment challenges.
- Cardiac transplantation is not a viable option for all advanced heart failure patients.
Purpose of the Study:
- To evaluate the feasibility and efficacy of outpatient intravenous dobutamine therapy.
- To assess patient outcomes, including wean rates from therapy and hospital readmissions.
Main Methods:
- Eleven patients with class IV congestive heart failure received outpatient intravenous dobutamine.
- Hemodynamic evaluations and arrhythmia monitoring were conducted.
- Patients were instructed on self-administration using external infusion pumps.
Main Results:
- Six patients were discharged on continuous dobutamine infusion; four on intermittent infusions.
- Seven of 11 patients were successfully weaned to oral therapy alone.
- Seven patients experienced no hospital readmissions during the study period.
Conclusions:
- Outpatient intravenous dobutamine is a feasible treatment option for select advanced heart failure patients.
- Ambulatory dobutamine therapy can lead to successful weaning and reduced hospitalizations.
Abstract:
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.