Intermittent infusions of carperitide or inotoropes in out-patients with advanced heart failure.

The ambulatory treatment of advanced heart failure (HF) with intermittent infusions of inotropes or natriuretic peptide chosen immediately before each infusion has not been described. Between May 2005 and July 2009, we treated 11 patients presenting with advanced HF, who received a total of 369 infusions of carperitide, olprinone, dopamine, or dobutamine, once or twice weekly. The pharmaceutical was selected before each infusion based on the systolic blood pressure (BP). Carperitide, olprinone, and catecholamines were administered to 8 (73 infusions of 0.030±0.004μg/kg/min for 3.3±0.8h), 4 (18 infusions of 0.070±0.017μg/kg/min for 3.3±0.5h), and 6 patients (278 infusions of 3.6±1.9μg/kg/min for 2.8±1.0h), respectively. No adverse effect requiring cessation of infusion was observed. Over a mean follow-up of 29.3±28.8months (range 2-104), 4 patients died, all from cardiac causes. The Kaplan-Meier cumulative survival rate was 69.3% at 20 months (median follow-up). Compared with the pre-infusion period, the duration and number of hospitalizations for management of HF were decreased by 73.9% (p=0.017), and 51.9% (p=0.007), respectively, during the treatment period, and the overall medical costs by 56.9% (p=0.021). In this study population, intermittent drug infusions selected from inotropes or natriuretic peptide based on the baseline systolic BP significantly decreased the length and number of hospitalizations and costs, without increasing mortality. These results indicate that intermittent infusions might be one of the therapeutic options in advanced HF.