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Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure

Current guidelines recommend the consideration of positive inotropes in patients with acute decompensated heart failure (ADHF) who have low cardiac index and evidence of systemic hypoperfusion or congestion. However, there is no evidence detailing the first line agent for the management of ADHF. The...

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Autores principales: Kelly, Julie, Cheng, Judy, Malloy, Rhynn, Lupi, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Cardiovascular Pharmacology 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249484/
https://www.ncbi.nlm.nih.gov/pubmed/32091426
http://dx.doi.org/10.1097/FJC.0000000000000811
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author Kelly, Julie
Cheng, Judy
Malloy, Rhynn
Lupi, Kenneth
author_facet Kelly, Julie
Cheng, Judy
Malloy, Rhynn
Lupi, Kenneth
author_sort Kelly, Julie
collection PubMed
description Current guidelines recommend the consideration of positive inotropes in patients with acute decompensated heart failure (ADHF) who have low cardiac index and evidence of systemic hypoperfusion or congestion. However, there is no evidence detailing the first line agent for the management of ADHF. The purpose of this study was to compare the safety and efficacy of dobutamine to milrinone for the treatment of ADHF. This was a single-center, retrospective study at a tertiary academic medical center, approved by Partner's Health Care Institutional Review Board. Patients included in this study were those admitted with ADHF who received dobutamine or milrinone from June 2015 to July 2017. A total of 95 dobutamine and 40 milrinone patients were included in the analysis. Median hospital length of stay was 12 days in the dobutamine group versus 10 days in the milrinone group (P = 0.34). Rehospitalization within 30 days occurred in 29.5% of patients in the dobutamine group versus 17.5% of patients in the milrinone group (P = 0.15). Median intensive care unit length of stay was 4.5 days in the dobutamine group versus 10 days in the milrinone group (P < 0.01). All other minor end points including all-cause mortality, progression to renal failure within 72 hours, rehospitalization in 90 days, and urine output within 72 hours of therapy were not found to be statistically significant. In addition, a post hoc analysis compared major and minor outcomes between milrinone and dobutamine using linear and logistic regression with adjustment for baseline characteristics. There were not any statistically significant findings in the post hoc analysis. Overall, there were no statistically significant differences in outcomes between the 2 groups other than longer intensive care unit length of stay in the milrinone group.
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spelling pubmed-72494842020-06-15 Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure Kelly, Julie Cheng, Judy Malloy, Rhynn Lupi, Kenneth J Cardiovasc Pharmacol Original Article Current guidelines recommend the consideration of positive inotropes in patients with acute decompensated heart failure (ADHF) who have low cardiac index and evidence of systemic hypoperfusion or congestion. However, there is no evidence detailing the first line agent for the management of ADHF. The purpose of this study was to compare the safety and efficacy of dobutamine to milrinone for the treatment of ADHF. This was a single-center, retrospective study at a tertiary academic medical center, approved by Partner's Health Care Institutional Review Board. Patients included in this study were those admitted with ADHF who received dobutamine or milrinone from June 2015 to July 2017. A total of 95 dobutamine and 40 milrinone patients were included in the analysis. Median hospital length of stay was 12 days in the dobutamine group versus 10 days in the milrinone group (P = 0.34). Rehospitalization within 30 days occurred in 29.5% of patients in the dobutamine group versus 17.5% of patients in the milrinone group (P = 0.15). Median intensive care unit length of stay was 4.5 days in the dobutamine group versus 10 days in the milrinone group (P < 0.01). All other minor end points including all-cause mortality, progression to renal failure within 72 hours, rehospitalization in 90 days, and urine output within 72 hours of therapy were not found to be statistically significant. In addition, a post hoc analysis compared major and minor outcomes between milrinone and dobutamine using linear and logistic regression with adjustment for baseline characteristics. There were not any statistically significant findings in the post hoc analysis. Overall, there were no statistically significant differences in outcomes between the 2 groups other than longer intensive care unit length of stay in the milrinone group. Journal of Cardiovascular Pharmacology 2020-05 2020-02-20 /pmc/articles/PMC7249484/ /pubmed/32091426 http://dx.doi.org/10.1097/FJC.0000000000000811 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Kelly, Julie
Cheng, Judy
Malloy, Rhynn
Lupi, Kenneth
Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title_full Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title_fullStr Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title_full_unstemmed Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title_short Comparison of Positive Inotropic Agents in the Management of Acute Decompensated Heart Failure
title_sort comparison of positive inotropic agents in the management of acute decompensated heart failure
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249484/
https://www.ncbi.nlm.nih.gov/pubmed/32091426
http://dx.doi.org/10.1097/FJC.0000000000000811
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