A prospective study of continuous intravenous milrinone therapy for status IB patients awaiting heart transplant at home

Background We performed a prospective study to determine the feasibility and safety of continuous intravenous milrinone therapy administered at home in patients listed as Status IB for heart transplant. Methods Patients who were Status IB could participate if they met specific criteria including an optimal dose of milrinone ≤0.5 μg/kg/min, presence of an implantable cardioverter-defibrillator (ICD), and no other serious comorbidity. The primary end-point of the study was survival to transplant. Hospitalizations, quality of life and cost comparisons were assessed. Results From May 1999 through October 2002, a total of 60 patients (51 men, 9 women), aged 55.5 ± 8.4 years, entered the study. Before milrinone therapy, cardiac index was 1.98 ± 0.66 liters/min/m² and peak oxygen consumption was 11.4 ± 2.6 ml/kg/min. Mean time in the study was 160.1 ± 151.8 days. Fifty-three patients (88.3%) underwent heart transplant. There were only 2 deaths during the study. There were 89 hospital admissions in 46 patients over the 43-month follow-up period; 58 of these admissions were for heart failure. There were 6 episodes of ICD firing for ventricular tachycardia. Quality-of-life measures in a sub-group of patients significantly improved 1 month after discharge. Substantial estimated cost savings occurred. Conclusions Continuous intravenous milrinone therapy can be safely administered at home in selected patients with advanced heart failure who are listed for transplant. This strategy may be an acceptable alternative to prolonged hospitalization for patients dependent on continuous inotropic support. Re-hospitalization is to be expected. An implantable cardioverter-defibrillator should be present due to the incidence of ventricular tachycardia.