The Mortality Benefit of Milrinone as a Continuous Outpatient Intravenous Inotrope Therapy in Advanced Heart Failure: A Systemic Review and Meta-Analysis.

https://e-heartfailure.org Advanced (stage D) heart failure (AHF) is defined by severe and refractory symptoms, not responding to maximum guideline-directed medical therapy, that markedly interfere with daily life and lead to recurrent hospitalizations.1) According to the AHA/ACC/ESFA 2022 guideline, continuous outpatient intravenous inotrope therapy is a strategy used as in interim treatment to those with AHF awaiting for mechanical circulatory support or cardiac transplantation (class IIa recommendation) and palliative treatment to improve symptom and functional status (class IIb recommendation).1) Milrinone and dobutamine are the most frequently used intravenous inotropes.2) Despite the aforementioned recommendation, there’s a sparsity of data comparing the benefit between those inotropic agents. Recent randomized-controlled trial and meta-analyses did not show an advantage of milrinone over dobutamine with regards to in-hospital mortality in patients with acute cardiogenic shock3-5); however, there was an increasing mortality benefit of milrinone over time, suggesting the possibility of time-dependent effect.4) A systemic review and meta-analysis was, therefore, performed to compare the mortality benefit between continuous outpatient intravenous therapy with milrinone and dobutamine.