INTERMITTENT DOBUTAMINE HYDROCHLORIDE INFUSIONS IN OUTPATIENTS WITH CHRONIC CONGESTIVE HEART-FAILURE

  • 1 January 1985
    • journal article
    • research article
    • Vol. 4  (2) , 195-199
Abstract
Patients with severe chronic congestive heart failure were treated with intermittent dobutamine HCl infusions administered on an outpatient basis with a portable infusion device. Patients (11, 8 women and 3 men), age 28-71 yr were given initial dobutamine HCl infusions at a rate of 1-2 .mu.g/kg per min and the dose was gradually increased to a maximum dose of 15 .mu.g/kg per min. Patients were considered dobutamine responders if their cardiac output increased by at least 30% and pulmonary-capillary wedge pressure did not rise. After a sustained hemodynamic response was demonstrated, the infusion was discontinued to assess the patients'' symptoms during drug-free intervals. The patients were instructed and trained in proper catheter care after a venous-access catheter was surgically implanted. Patients were also shown how to use the ambulatory infusion pump. The patients were treated with long-term intermittent dobutamine HCl infusions for 3-24 mo. All patients adjusted easily to the routine of catheter and pump care and drug administration. The mean dose of dobutamine HCl resulting in the maximum improvement in cardiac index was 9.4 .mu.g/kg per min. All patients observed an improvement in their symptoms of congestive heart failure during the drug infusions and the intervals between the infusions. There was a mean reduction of 1.2 in New York Heart Association functional class. There were 18 congestive heart failure-related hospital readmissions among the 11 patients during 108 cumulative mo. of long-term dobutamine therapy. The intermittent administration of dobutamine HCl via a portable infusion system appears to have improved the functional capacity of the 11 patients studied. This may be a viable treatment alternative for selected ambulatory patients with severe heart failure who demonstrate hemodynamic improvement with dobutamine.

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