Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receiving dobutamine versus nesiritide therapy (original) (raw)
2001, The American Journal of Cardiology
Ventricular arrhythmias are common in patients with congestive heart failure (CHF) and may be exacerbated by positive inotropic therapy. Because human B-type natriuretic peptide (nesiritide), an arterial and venodilator, inhibits sympathetic activity, it may decrease the incidence of arrhythmias. Our investigation compares the arrhythmogenicity of dobutamine with nesiritide. A total of 305 patients with decompensated CHF requiring intravenous vasoactive therapy were randomized to receive standard therapy (n ؍ 102) or nesiritide (0.015 g/kg/min [n ؍ 103] or 0.030 g/kg/min [n ؍ 100]) to gain additional data on the relative safety and efficacy of nesiritide compared with standard parenteral care. Dobutamine was chosen as the standard care agent in 58 subjects. During study drug infusion, all patients had continuous clinical hemodynamic and electrocardiographic monitoring. The dobutamine and ne-siritide groups were similar with respect to baseline use of antiarrhythmic agents, including  blockers. Serious arrhythmias and the incidence of cardiac arrest were more common in patients who received dobutamine than in those taking nesiritide: sustained ventricular tachycardia, 4 (7%) versus 2 (1%), respectively (p ؍ 0.014); nonsustained ventricular tachycardia, 10 (17%) versus 23 (11%), respectively (p ؍ 0.029); cardiac arrest, 3 (5%) versus 0, respectively (p ؍ 0.011). We conclude that among patients with decompensated CHF for whom dobutamine is selected as standard therapy, the incidence of serious ventricular arrhythmias and cardiac arrest is significantly greater than the incidence of these events in patients randomized to nesiritide.
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Journal of the American College of Cardiology, 2002
OBJECTIVES This study was designed to determine whether nesiritide, administered for acute decompensated congestive heart failure (CHF), affects healthcare costs by hospital length of stay (LOS), readmissions and short-term mortality, compared to dobutamine. BACKGROUND Dobutamine is a commonly used inotropic treatment for CHF. Although dobutamine may have favorable hemodynamic and symptomatic effects, its use may be associated with side effects such as tachycardia, cardiac arrhythmias and myocardial ischemia. Nesiritide (B-type natriuretic peptide) is a new intravenous (IV) drug that produces hemodynamic and symptomatic improvement through balanced vasodilatory effects, neurohormonal suppression and enhanced natriuresis and diuresis. METHODS From an open-label randomized study of nesiritide versus standard care (SC) in patients with CHF requiring hospitalization, we compared short-term outcome data from patients given nesiritide (0.015 or 0.03 g/kg per min) with a subgroup of SC patients given dobutamine. A total of 261 patients are included in this analysis. RESULTS Compared to dobutamine, both nesiritide doses were administered for a shorter total duration (p Ͻ 0.001), and the total duration of all IV vasoactive therapy (including study drug) was also shorter (p Յ 0.012). Although there was no difference in LOS, there was a trend toward decreased readmissions in the two nesiritide groups (8% and 11%, respectively, vs. 20% in the dobutamine group). Six-month mortality was lower in the nesiritide groups. CONCLUSIONS Treatment of decompensated CHF with nesiritide may lead to lower healthcare costs and reduced mortality compared to treatment with dobutamine.
Short- and long-term dobutamine treatment in chronic ischemic heart failure
Clinical Cardiology, 1987
This study was undertaken in order to characterize the short-term (1 hour) and long-term (72 hours) effect of dobutamine on hemodynamic and regional ejection fraction parameters measured by radionuclear angiography in patients with chronic congestive heart failure due to coronary artery disease. Baseline hemodynamic and radionuclear parameters were measured and then intravenous dobutamine (8.5 p/kg/min) was administered. The above parameters were determined again after 1 hour and 72 hours of continuous dobutamine administration. Sixty minutes (short-term) after dobutamine administration heart rate and cardiac index increased significantly (p <0.001 for both) and peripheral resistance decreased concomitantly (p ~0 . 0 0 5 ) . Global left ventricular ejection fraction (LVEF) as measured by multigated equilibrium nuclear angiography (MUGA) increased from 21.8f 10.6% to 25f13.5 (~~0 . 0 2 ) .
Hemodynamic effect of dobutamine in patients with severe heart failure
American Journal of Cardiology, 1975
Dobutamine, a derivative of dopamine, was infused at a rate of 10 pg/kg per min in 15 patients with severe congestive heart failure. Cardiac output increased from an average of 3.1 to 5.6 liters/min (P <O.OOl) with no change in mean arterial pressure (93.3 to 96.2 mm Hg) and only a slight increase in heart rate (98.5 to 105.2 beats/min) (P <0.02). Pulmonary wedge pressure was decreased from an average of 27.4 to 21.1 mm Hg (P <O.OOl). In seven patients a dose of 5 fig/kg per min also produced a significant increase in cardiac output but the effect was less than with the 10 pg/kg per min dose. No side effects were observed during the infusion. Dobutamine therefore is a potent inotropic drug with limited chronotropic and peripheral vascular effects and deserves therapeutic trial in the short-term management of low output heart failure.
Cardiovascular effects of dobutamine in severe congestive heart failure
American Heart Journal, 1977
Sympathomimetic agents are frequently used in the treatment of refractory cardiac failure. '-~ Howeverl available agents are limited by their tendency to produce potentially deleterious changes in heart rate, rhythm, and blood pressure. '-' "~ A substance that provides an isolated increase in myocardial contractility should prove clinically valuable. Dobutamine was synthesized by Tuttle and Mills ~. s and early animal studies demonstrated that in the dose range of 5 to 20 tLg/Kg./min., it is selectively inotropic? A comparative study of the effects of dopamine (the only other selective sympathomimetic agent 4) and dobutamine in dogs showed that dobutamine increased cardiac output to a'greater extent than does dopamine. TM The present study was designed to evaluate the effectiveness and safety of dobutamine in patients with severe congestive heart failure. Methods The effect of dobutamine was assessed hemodynamically, echocardiographically, and by measurement of the systolic time intervals. Seventeen
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