PMID- 10426835
OWN - NLM
STAT- MEDLINE
DCOM- 19990826
LR  - 20190626
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 138
IP  - 2 Pt 1
DP  - 1999 Aug
TI  - Intermittent 6-month low-dose dobutamine infusion in severe heart failure: DICE 
      multicenter trial.
PG  - 247-53
AB  - BACKGROUND: Patients with end-stage heart failure are often refractory to maximal 
      oral therapy, and they have high mortality rates, poor quality of life, and 
      frequent hospitalizations with elevated health care costs. Intermittent 
      dobutamine therapy has been suggested as an additional option in this clinical 
      setting. METHODS AND RESULTS: Thirty-eight patients clinically stable for at 
      least 48 hours with standard treatment, New York Heart Association (NYHA) 
      functional class III or IV, cardiac index </=2.2 L/min/m(2), and left ventricular 
      ejection fraction </=30% were randomly assigned to ambulatory intermittent 
      dobutamine or optimal standard treatment. Dobutamine was infused at 2.5 
      microgram/kg/min with a portable pump 48 hours/week for 6 months. The primary 
      study end point was the reduction of hospitalizations for worsening of congestive 
      heart failure (CHF); changes in NYHA functional class, 6-minute walking test, and 
      mortality rates were secondary end points. During the 6-month follow-up, all 
      patients in dobutamine and control groups underwent weekly clinical visits with 
      serum sodium and potassium measurement. Baseline characteristics were age 65 +/- 
      2 years, NYHA class III/IV 17/21, ejection fraction 22% +/- 1%, and cardiac index 
      1.89 +/- 0.1 L/min/m(2), without differences between treatment groups. 
      Hospitalizations for all causes over a 6-month period were 17 and 11 in control 
      and dobutamine groups; 11 of 17 and 7 of 11 were for worsening CHF. Four control 
      patients but none in the dobutamine group had 2 or more hospitalizations for 
      worsening of CHF. There were no significant differences in NYHA functional class 
      and in 6-minute walking test. Three patients in the control group died and 5 in 
      the dobutamine group died. Two patients in the dobutamine group underwent heart 
      transplantation. Protocol was discontinued in the dobutamine group for severe 
      ventricular arrhythmias (1 patient), infusion system failure (1 patient), and 
      consent withdrawal (1 patient). In 3 patients in the dobutamine group, drug dose 
      was increased to 5 microgram/kg/min because of CHF. CONCLUSIONS: Six-month 
      intermittent low-dose dobutamine administration was well tolerated by patients 
      with severe CHF; it did not improve the functional status and did not 
      significantly increase the mortality rate as found with higher dobutamine doses 
      in other studies. Hospitalizations for all causes and for worsening of CHF tended 
      to be fewer in the dobutamine group.
FAU - Oliva, F
AU  - Oliva F
AD  - Division of Cardiology, Ospedale Niguarda, Milan, Italy.
FAU - Latini, R
AU  - Latini R
FAU - Politi, A
AU  - Politi A
FAU - Staszewsky, L
AU  - Staszewsky L
FAU - Maggioni, A P
AU  - Maggioni AP
FAU - Nicolis, E
AU  - Nicolis E
FAU - Mauri, F
AU  - Mauri F
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Cardiotonic Agents)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
CIN - Am Heart J. 1999 Aug;138(2 Pt 1):191-2. PMID: 10426825
MH  - Adult
MH  - Aged
MH  - Cardiac Output
MH  - Cardiotonic Agents/*administration & dosage/therapeutic use
MH  - Dobutamine/*administration & dosage/therapeutic use
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Heart Rate
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Wedge Pressure
MH  - Treatment Outcome
EDAT- 1999/07/30 00:00
MHDA- 1999/07/30 00:01
CRDT- 1999/07/30 00:00
PHST- 1999/07/30 00:00 [pubmed]
PHST- 1999/07/30 00:01 [medline]
PHST- 1999/07/30 00:00 [entrez]
AID - S0002870399000125 [pii]
AID - 10.1016/s0002-8703(99)70108-0 [doi]
PST - ppublish
SO  - Am Heart J. 1999 Aug;138(2 Pt 1):247-53. doi: 10.1016/s0002-8703(99)70108-0.