Comparison of dobutamine-based and milrinone-based therapy for advanced decompensated congestive heart failure: Hemodynamic efficacy, clinical outcome, and economic impact

Background The use of parenteral positive inotropic agents still remains a major component of therapy for patients with advanced decompensated congest ive heart failure (CHF). However, no consensus guidelines have been develop ed for the appropriate selection of a first-line inotropic therapy. We soug ht to compare the clinical outcome and economic cost of dobutamine-based an d milrinone-based therapy in patients with acute exacerbation of CHF. Methods and Results We retrospectively analyzed the outcome of 329 patients admitted to the heart failure unit with acute exacerbation of CHF. More pa tients were treated with dobutamine-based therapy (269/329, 81.7%) than wit h milrinone-based therapy (60/329, 18.3%). Both groups had similar baseline characteristics and similar hemodynamic profiles at baseline, with the exc eption of higher mean pulmonary arterial pressure in the milrinone group (4 7 mm Hg vs 42 mm Hg, P <.001). One hundred nine patients (40%) of the dobut amine group required parenteral nitroprusside for hemodynamic optimization compared with 11 patients (18%) in the milrinone group (P <.001). The use o f parenteral nitroglycerin and dopamine was similar in both groups. There w as no significant difference in the in-hospital mortality rate (dobutamine 7.8% vs milrinone 10%) or clinical outcome between the 2 groups. However, t he average direct drug cost per patient was significantly reduced in the do butamine group compared with the milrinone group ($45 +/- $10 vs $1855 +/- $350, P < .0001). Conclusion Dobutamine-based therapy is an attractive approach for the treat ment of decompensated advanced heart failure, achieving comparable clinical efficacy to milrinone with a significantly reduced economic cost.