Clinical Question: Do intermittent infusions of dobutamine improve outcomes in patients with end-stage heart failure?
Setting: Inpatient (any location) with outpatient follow-up
Study Design: Randomized controlled trial (double-blinded)
Synopsis: Dobutamine has never been shown to improve mortality rates in patients with end-stage heart failure. In this study, researchers identified 30 patients with heart failure who were still symptomatic despite therapy with digoxin, enalapril, spirono-lactone, and diuretics, and who could be weaned from dobutamine after a first 72-hour infusion.
All 30 participants were given amiodarone at a final dosage of 400 mg per day, unless they had an implanted defibrillator, in which case they received 800 mg per day. They were then randomized (allocation concealment uncertain) to eight hours of dobutamine, in a dosage of 8 mcg per kg per minute every 14 days, or placebo. Patients were allowed to cross over to dobutamine therapy; four of 16 patients in the placebo group did so, which may have affected the blinding. However, analysis was by intention to treat. Patients were followed for two years.
The rate of survival was higher in the dobutamine group at one year (69 percent versus 28 percent for control patients; P = .02; number needed to treat [NNT] = 2.5) and at two years (44 percent versus 21 percent; P = .04; NNT = 4.3). The median survival rate was 574 days for dobutamine-treated patients and 144 days for control patients. The New York Heart Association functional class showed a greater improvement at three months in the treatment group (4.0 to 2.8 versus 4.0 to 3.2 in the control group), but the article does not provide the appropriate comparisons to determine if this difference is statistically significant. Data on side effects and tolerability were not given.
Bottom Line: The results of this small study suggest that intermittent infusions of dobutamine can reduce the rate of mortality in patients with end-stage heart failure who have not responded to other therapies. (Level of Evidence: 1b–)