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Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST).

Publication ,  Journal Article
O'Connor, CM; Gattis, WA; Uretsky, BF; Adams, KF; McNulty, SE; Grossman, SH; McKenna, WJ; Zannad, F; Swedberg, K; Gheorghiade, M; Califf, RM
Published in: Am Heart J
July 1999

OBJECTIVE: To evaluate clinical characteristics and outcomes of patients with advanced heart failure receiving intravenous continuous dobutamine in the FIRST Trial (Flolan International Randomized Survival Trial). METHODS: Four hundred seventy-one patients with class IIIb to IV heart failure who were enrolled in the FIRST trial were included. Eighty patients treated with dobutamine at FIRST randomization were compared with 391 patients not treated with dobutamine at randomization. The occurrence of worsening heart failure, need for vasoactive medications, resuscitated cardiac arrest, myocardial infarction, and total mortality were compared between the 2 groups. RESULTS: The dobutamine group had a higher occurrence of first event (85.3% vs 64. 5%; P =.0006) and a higher mortality rate (70.5% vs 37.1%; P =.0001) compared with the no dobutamine group. Intravenous continuous dobutamine was an independent risk factor for death after adjusting for baseline differences. CONCLUSIONS: Dobutamine use at the time of randomization was associated with a higher 6-month mortality rate. This effect persisted after adjustment for baseline differences. This analysis challenges the concept that continuous intravenous dobutamine is beneficial to advanced heart failure patients with respect to survival.

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Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

July 1999

Volume

138

Issue

1 Pt 1

Start / End Page

78 / 86

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Risk
  • Middle Aged
  • Male
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Female
 

Citation

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O’Connor, C. M., Gattis, W. A., Uretsky, B. F., Adams, K. F., McNulty, S. E., Grossman, S. H., … Califf, R. M. (1999). Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST). Am Heart J, 138(1 Pt 1), 78–86. https://doi.org/10.1016/s0002-8703(99)70250-4
O’Connor, C. M., W. A. Gattis, B. F. Uretsky, K. F. Adams, S. E. McNulty, S. H. Grossman, W. J. McKenna, et al. “Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST).Am Heart J 138, no. 1 Pt 1 (July 1999): 78–86. https://doi.org/10.1016/s0002-8703(99)70250-4.
O’Connor, C. M., et al. “Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST).Am Heart J, vol. 138, no. 1 Pt 1, July 1999, pp. 78–86. Pubmed, doi:10.1016/s0002-8703(99)70250-4.
O’Connor CM, Gattis WA, Uretsky BF, Adams KF, McNulty SE, Grossman SH, McKenna WJ, Zannad F, Swedberg K, Gheorghiade M, Califf RM. Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1999 Jul;138(1 Pt 1):78–86.
Journal cover image

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

July 1999

Volume

138

Issue

1 Pt 1

Start / End Page

78 / 86

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Risk
  • Middle Aged
  • Male
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Female