INTERMITTENT INTRAVENOUS AMRINONE INFUSION - A POTENTIALLY COST-EFFECTIVE MODE OF TREATMENT OF PATIENTS WITH REFRACTORY HEART-FAILURE

OBJECTIVE: To describe the experience of 41 New York Heart Association (NYHA) class III and IV heart failure patients treated with intermitt ent intravenous amrinone infusions in addition to conventional therapy . BACKGROUND: Congestive heart failure is a condition often requiring repeated admission to hospital. Accordingly, a treatment modality whic h can reduce the number of admissions is desirable and potentially cos t-effective. DESIGN: Retrospective analysis of data from hospital and office charts. SETTING: Community hospital with 640 active beds. INTER VENTION: The initial amrinone infusion was administered in the hospita l under electrocardiographic monitoring; subsequent infusions were giv en in an out-patient unit. A bolus injection of 0.75 mg/kg followed by an infusion of 5 to 10 mug/kg/min for 8 to 12 h was administered ever y two to six weeks as clinically indicated. RESULTS: Results are repor ted for the first 51 months. Sixty-six per cent of the patients improv ed their NYHA class, 34% remained unchanged or deteriorated. Survival paralleled that of other studies involving similar patients not receiv ing nonglycoside positive inotropes. The number of days spent in the h ospital in the six months after starting on amrinone compared with the six months before treatment was reduced to 50% (P<0.05), and the numb er of hospital admissions in the six months after starting amrinone co mpared with the six months before decreased to 56% (P<0.05). CONCLUSIO NS: Intermittent intravenous amrinone infusions can be given in an out -patient setting in patients with NYHA class III to IV heart failure. This program is cost-effective, reducing hospital admissions and in-pa tient hospital days.