Continuous Outpatient Intravenous Inotrope Therapy: Milrinone is Associated with Improved Survival Compared to Dobutamine Irrespective of Indication

Abstract

Introduction Continuous outpatient intravenous inotrope therapy (COIIT) is a treatment strategy used in stage D heart failure as a bridge to advanced therapies [bridge-to-decision (BTD); bridge-to-mechanical support (BTMS); bridge-to-transplant (BTT)] or as palliation (PAL). Long-term survival associated with COIIT in the modern era of guideline directed medical and device therapy (GDMDT) is poorly defined. Our objective is to describe the survival of patients undergoing COIIT with milrinone or dobutamine in the modern era. Hypothesis In patients undergoing COIIT for various indications, milrinone - which allows for more effective neurohormonal antagonism with beta blockade - has a more favorable survival profile than dobutamine. Methods We retrospectively analyzed data from a large US registry of patients receiving COIIT (milrinone or dobutamine) from 2015-17. Patients with incomplete data or Results Of 1,149 patients on COIIT (mean age 60 years, 29.9% female), 260 (22.6%) patients died during the study period. Mortality was higher in patients undergoing COIIT for palliation than for bridge therapy (1-year survival: 55.0% vs 65.6%, p Conclusions In the largest data set reported to date of patients receiving COITT in the current era of GDMDT, milrinone use was associated with improved survival compared to dobutamine. A randomized, controlled trial in this growing patient population is warranted.