1
|
Abdel-Razek O, Di Santo P, Jung RG, Parlow S, Motazedian P, Prosperi-Porta G, Visintini S, Marbach JA, Ramirez FD, Simard T, Labinaz M, Mathew R, Hibbert B. Efficacy of Milrinone and Dobutamine in Cardiogenic Shock: An Updated Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0962. [PMID: 37649849 PMCID: PMC10465094 DOI: 10.1097/cce.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES Inotropic support is commonly used in patients with cardiogenic shock (CS). High-quality data guiding the use of dobutamine or milrinone among this patient population is limited. We compared the efficacy and safety of these two inotropes among patients with low cardiac output states (LCOS) or CS. DATA SOURCES MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched up to February 1, 2023, using key terms and index headings related to LCOS or CS and inotropes. DATA EXTRACTION Two independent reviewers included studies that compared dobutamine to milrinone on all-cause in-hospital mortality, length of ICU stay, length of hospital stay, and significant arrhythmias in hospitalized patients. DATA SYNTHESIS A total of eleven studies with 21,084 patients were included in the meta-analysis. Only two randomized controlled trials were identified. The primary outcome, all-cause mortality, favored milrinone in observational studies only (odds ratio [OR] 1.19 (95% CI, 1.02-1.39; p = 0.02). In-hospital length of stay (LOS) was reduced with dobutamine in observational studies only (mean difference -1.85 d; 95% CI -3.62 to -0.09; p = 0.04). There was no difference in the prevalence of significant arrhythmias or in ICU LOS. CONCLUSIONS Only limited data exists supporting the use of one inotropic agent over another exists. Dobutamine may be associated with a shorter hospital LOS; however, there is also a potential for increased all-cause mortality. Larger randomized studies sufficiently powered to detect a difference in these outcomes are required to confirm these findings.
Collapse
Affiliation(s)
- Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiovascular Medicine, Knight Cardiovascular Center, Oregon Health and Science University, Portland, OR
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
2
|
Chen F, Fang B, Wang S. A Fast and Validated HPLC Method for Simultaneous Determination of Dopamine, Dobutamine, Phentolamine, Furosemide, and Aminophylline in Infusion Samples and Injection Formulations. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2021; 2021:8821126. [PMID: 33728093 PMCID: PMC7936887 DOI: 10.1155/2021/8821126] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 05/20/2023]
Abstract
A simple, fast, and validated HPLC method was developed for the simultaneous quantization of five cardiovascular agents: dopamine (DPM), dobutamine (DBM), phentolamine (PTM), furosemide (FSM), and aminophylline (APL) either in infusion samples or in an injection dosage form. The proposed method was achieved with a 150 mm × 4.6 mm, 5.0 μm C18 column, by using a simple linear gradient. Mobile phase A was buffer (50 mM KH2PO4) and mobile Phase B was acetonitrile at a flow rate of 1.0 mL/min. The column temperature was kept at 30°C, and the injection volume was 20 μL. All analytes were separated simultaneously at a retention time (tr) of 3.93, 5.84, 7.06, 8.76, and 9.67 min for DPM, DBM, PTM, FSM, and APL, respectively, with a total run time of less than 15.0 min. The proposed method was validated according to ICH guidelines with respect to accuracy, precision, linearity, limit of detection, limit of quantitation, and robustness. Linearity was obtained over a concentration range of 12.0-240.0, 12.0-240.0, 20.0-200.0, 6.0-240.0, and 10.0-200.0 μg/mL DPM, DBM, PTM, FSM, and APL, respectively. Interday and intraday accuracy and precision data were recorded in the acceptable limits. The new method has successfully been applied for quantification of all five drugs in their injection dosage form, infusion samples, and for evaluation of the stability of investigated drugs in mixtures for endovenous use. The results of the stability study showed that mixtures of DPM, DBM, PTM, FSM, and APL in 5% glucose or 0.9% sodium chloride injection were stable for 48 hours when stored in polypropylene syringes at 25°C.
Collapse
Affiliation(s)
- Fuchao Chen
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, Shanxi, China
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Baoxia Fang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Sicen Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, Shanxi, China
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| |
Collapse
|
3
|
Hauptman PJ, Swindle J, Burroughs TE, Schnitzler MA. Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. Am Heart J 2008; 155:978-985.e1. [PMID: 18513507 DOI: 10.1016/j.ahj.2008.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/22/2008] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database. METHODS Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics. RESULTS Total number of hospitalizations was 278,214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234,204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age <75 years, non-black race, male sex, and urban teaching hospital status. CONCLUSIONS Length of stay is the determinant of cost for HF hospitalizations. Use of vasoactive therapy is a marker for longer LOS, higher mortality, and greater costs. Improved reimbursement rates or improved therapeutic options that lessen LOS are required if the costs of HF care are to be minimized.
Collapse
Affiliation(s)
- Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St Louis, MO 63110, USA.
| | | | | | | |
Collapse
|
4
|
Komamura K, Matsuo H, Sasaki T. Comparison of the initial hospitalization costs between the patients treated with dobutamine and the patients treated with amrinone for acute decompensated heart failure in a Japanese institute. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11 Suppl 1:S39-S42. [PMID: 18387066 DOI: 10.1111/j.1524-4733.2008.00365.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Phosphodiesterase (PDE) III inhibitor therapy is effective for treatment of acute decompensated heart failure (ADHF). Nevertheless, this drug is expensive than conventional inotropic agent dobutamine. We compared total medication costs of the patients treated with PDE III inhibitor amrinone therapy to that of the patients treated with conventional dobutamine therapy during initial hospitalization. METHODS We analyzed 160 consecutive patients with ADHF admitted to our hospital. Shock, dehydration, severe infection, multiple organ failure, and mild heart failure (New York Heart Association class IIs) were not eligible for the study. Ninety-seven patients were divided into two groups: 1) DOB group treated with dobutamine therapy; and 2) AMR group treated with amrinone therapy. Total medication costs and cost for hospital room charge were calculated based on their usage during the initial hospitalization for each patient. Group comparison was done between the DOB and AMR groups. RESULTS Length of stay was longer in the DOB group than in the AMR group. Mean calculated cost of intravenous drugs was higher in the DOB group (173,186 +/- 239,147 yen) than in the AMR group (63,145 +/- 47,223 yen, P < 0.05). Total medication costs were higher in the DOB group than in the AMR group. Cost for hospital room charge was higher in the DOB group than in the AMR group. CONCLUSIONS In the treatment of ADHF, appropriate therapy even with expensive drugs makes total medication costs less expensive comparing with conventional therapy with cheaper drugs during initial hospitalization.
Collapse
Affiliation(s)
- Kazuo Komamura
- Department of Cardiovascular Dynamics, Research Institute, National Cardiovascular Center, Fujishirodai, Suita, Japan.
| | | | | |
Collapse
|
5
|
Woodard GE, Rosado JA. Recent advances in natriuretic peptide research. J Cell Mol Med 2007; 11:1263-71. [PMID: 18205700 PMCID: PMC4401292 DOI: 10.1111/j.1582-4934.2007.00125.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 09/05/2007] [Indexed: 12/02/2022] Open
Abstract
The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular and renal homeostasis. They have recently emerged as potentially important clinical biomarkers in heart failure. Natriuretic peptides, particularly brain natriuretic peptide (BNP) and the inactive N-terminal fragment of BNP, NT-proBNP, that has an even greater half-life than BNP, are elevated in heart failure and therefore considered to be excellent predictors of disease outcome. Nesiritide, a recombinant human BNP, has been shown to provide symptomatic and haemodynamic improvement in acute decompensated heart failure, although recent reports have suggested an increased short-term risk of death with nesiritide use. This review article describes: the current use of BNP and its inactive precursor NT-proBNP in diagnosis, screening, prognosis and monitoring of therapy for congestive heart failure, the renoprotective actions of natriuretic peptides after renal failure and the controversy around the therapeutic use of the recombinant human BNP nesiritide.
Collapse
Affiliation(s)
- Geoffrey E Woodard
- The National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1876, USA.
| | | |
Collapse
|