Outpatient milrinone safe for end-stage heart failure

Continuous treatment with milrinone infusions is safe in outpatients with end-stage heart failure and provides probable survival benefits, a new study has shown.

Researchers conducted a retrospective analysis of 98 patients (mean age, 70.0±11.7 years; 72 percent male) undergoing treatment with milrinone infusions. All patients had advanced heart failure. The primary endpoint was overall survival, while the need for post-treatment implantable cardioverter defibrillator (ICD) shocks and the development of ventricular tachyarrhythmia were set as secondary outcomes.

The overall median patient survival duration was 581±96 days after milrinone initiation. Those who had a history of ventricular tachyarrhythmia or nonsustained tachycardia before milrinone treatment saw no significant effects of the treatment on their survival outlook, as opposed to those without such a history (p=0.16).

Similarly, milrinone treatment did not seem to exacerbate atrial fibrillation (AF). Thirty-two participants had AF before treatment initiation, and this percentage dropped to 72 percent by the third follow-up (p<0.05). Of the remaining patients, who had no AF before amiodarone treatment, did not develop AF as long as they were also on amiodarone.

Despite no differences in survival and AF outcomes, the frequency of ICD shocks was significantly greater in those who did vs did not have ventricular tachyarrhythmia before milrinone initiation (59 percent vs 6.5 percent; p<0.001).

“Among selected patients with end-stage heart failure who were not candidates for [left ventricular access device] transplantation, including those with evidence of atrial fibrillation or ventricular tachycardia, continuous outpatient milrinone infusion appeared to be safe and probably life prolonging,” researchers said.