Infusion therapy limited to severe disease
Drugs reduce symptoms and heart damage
Outpatient infusion therapy centers are springing up all over the country because they’re proven to provide quality, cost-effective care for patients with refractory congestive heart failure (CHF). Only patients with severe, New York Heart Association Class III or IV CHF receive the inotropic milrinone (Primacor) and dobutamine (Dobutrex). Class IV patients have a peak oxygen consumption (VO2) of less than 10 mL/min/kg. Class III VO2 is 13-15 mL/min/kg. Milrinone is used in most patients because it has the advantage of reducing peripheral vascular resistance with little effect on heart rate or myocardial oxygen consumption. In addition, it does not affect beta-adrenergic receptors and induced tolerance.
Intermittent low-dose inotropic therapy reduces symptoms of CHF. Paroxysmal nocturnal dyspnea, pedal edema, fatigue, shortness of breath, and loss of appetite are usually relieved within the first month. Hemodynamic benefits are improved cardiac output, decreased peripheral vascular resistance, and decreased pulmonary-artery wedge pressure, all of which improve the overall performance of a failing heart.