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Intermittent dobutamine hydrochloride infusions in outpatients with chronic congestive heart failure
Insights
Intermittent dobutamine hydrochloride infusions improved symptoms and functional capacity in severe chronic heart failure patients. This outpatient treatment offers a viable alternative for selected ambulatory patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe chronic heart failure significantly impacts patient quality of life and functional capacity.
- Current treatment options for advanced heart failure may have limitations for ambulatory patients.
Purpose of the Study:
- To evaluate the efficacy and feasibility of intermittent outpatient dobutamine hydrochloride infusions in patients with severe chronic heart failure.
- To assess the impact of this treatment on hemodynamic parameters, functional capacity, and hospital readmissions.
Main Methods:
- Eleven patients with severe chronic heart failure received intermittent dobutamine hydrochloride infusions via a portable pump on an outpatient basis.
- Dobutamine doses were titrated, and patients were assessed for hemodynamic response (cardiac output, pulmonary-capillary wedge pressure) and functional improvement (New York Heart Association class).
- Patients were trained in self-administration and catheter care for long-term treatment (3-24 months).
Main Results:
- Intermittent dobutamine infusions led to improved cardiac output and reduced pulmonary-capillary wedge pressure in responders.
- Patients experienced a mean reduction of 1.2 in New York Heart Association functional class.
- A significant decrease in heart failure-related hospital readmissions was observed during the treatment period.
Conclusions:
- Intermittent outpatient dobutamine hydrochloride administration is a potentially viable treatment for selected ambulatory patients with severe chronic heart failure.
- This approach can improve functional capacity and reduce hospitalizations, enhancing quality of life.
Abstract:
Patients with severe chronic congestive heart failure were treated with intermittent dobutamine hydrochloride infusions administered on an outpatient basis with a portable infusion device. Eleven patients (eight women and three men), ages 28-71 years, were given initial dobutamine hydrochloride infusions at a rate of 1-2 micrograms/kg/min, and the dose was gradually increased to a maximum dose of 15 micrograms/kg/min. Patients were considered dobutamine responders if their cardiac output increased by at least 30% and pulmonary-capillary wedge pressure did not rise. After a sustained hemodynamic response was demonstrated, the infusion was discontinued to assess the patients' symptoms during drug-free intervals. The patients were instructed and trained in proper catheter care after a venous-access catheter was surgically implanted. Patients were also shown how to use the ambulatory infusion pump. The patients were treated with long-term intermittent dobutamine hydrochloride infusions for 3-24 months. All patients adjusted easily to the routine of catheter and pump care and drug administration. The mean dose of dobutamine hydrochloride resulting in the maximum improvement in cardiac index was 9.4 micrograms/kg/min. All patients observed an improvement in their symptoms of congestive heart failure during the drug infusions and the intervals between the infusions. There was a mean reduction of 1.2 in New York Heart Association functional class. There were 18 congestive heart failure-related hospital readmissions among the 11 patients during 108 cumulative months of long-term dobutamine therapy. The intermittent administration of dobutamine hydrochloride via a portable infusion system appears to have improved the functional capacity of the 11 patients studied. This may be a viable treatment alternative for selected ambulatory patients with severe heart failure who demonstrate hemodynamic improvement with dobutamine.