Intravenous dobutamine therapy in class IV heart failure successfully weaned with carvedilol titration

Abstract

Clinical trials that established the use of beta blockers in heart failure have excluded patients with New York Heart Association (NYHA) Class IV symptoms. Thus, carvedilol is currently contraindicated in Class IV heart failure. We sought to improve the functional status of severe heart failure patients (n = 5) who were placed on home intravenous (IV) dobutamine for symptom improvement. These patients were optimized on heart failure medical regimen, had no options for invasive intervention, and were not candidates for cardiac transplantation. Carvedilol was initiated as a treatment modality after functional status improved with home dobutamine. Diuretics and ACE inhibitors were modified in response to hemodynamic changes. As carvedilol was slowly titrated, IV dobutamine was gradually weaned. During this time, patients were evaluated biweekly in a specialty heart failure clinic where vigilant patient education was provided in respect to chronic disease management, diet and exercise. Furthermore, patients were monitored by telephone, and medications were adjusted in response to laboratory findings and patient symptomatology. The average length of combined therapy with beta blocker and IV dobutamine was 3.5 -+ 1.8 months. The baseline mean ejection fraction (EF) prior to dobutamine infusion was