Continuous Dobutamine May Increase Risk of Mortality in Advanced CHF
By Carrie Wingate

	July 29, 1999 - In patients with advanced heart failure,
continuous intravenous dobutamine appears to increase the risk of
mortality and adverse events, according to data from the Flolan
International Randomized Survival Trial (FIRST).
	Dr. Christopher O'Connor, of Duke University Medical Center
and a multi-national team analyzed the outcome of 487 patients with
class 3 to class 4 heart failure, with an average patient age of 65.
Eighty patients received continuous dobutamine infusion, with an
average dose of 9 mcg/kg/min for 14 days.
	The research team found that within 6 months, a first adverse
event occurred in 85% of the dobutamine patients versus 65% of those
who were not given the drug. Adverse clinical events were defined as
worsening heart failure; need for intravenous vasodilators or mechanical
assist device; resuscitated sudden cardiac death, herat attack, or
death, according to the report in the July issue of American Heart
Journal.
	The 6-month mortality rate was nearly twice as high in the
dobutamine group (71%), than in the non-dobutamine patients (37%).
Even after adjustment for baseline characteristics, "dobutamine
persisted as one of the most important independent risk factors for
death in the study." The authors conclude that intravenous continuous
dobutamine may be harmful to patients with advanced heart failure
regarding survival.
	Co-investigator Dr. Wendy Gattis of Duke University noted that
the current study does not address short-term therapy. Dobutamine "may
be very helpful on a short-term basis," she said.

Am Heart J 1999;138:78-86