Brozena SC et al. (2004) A prospective study of continuous intravenous milrinone therapy for Status IB patients awaiting heart transplant at home. J Heart Lung Transplant 23: 1082–1086

Long-term milrinone therapy is common in patients with advanced heart failure awaiting transplant, although there is evidence that long-term administration of inotropic therapy increases mortality in these patients. Since the wait for a donor heart is often lengthy, Brozena et al. have studied the feasibility and safety of continuous intravenous milrinone therapy administered at home.

Sixty hospitalized patients listed as Status 1B for heart transplantion were included in the trial. All were inotrope-dependent and had an ICD. After initiation and adjustment of milrinone dose during hospitalization, milrinone was administered at home via an intravenous catheter and a preset, computerized pump.

During the 43-month follow-up period, 53 (88.3%) patients underwent successful heart transplantation. Two patients died while waiting for transplantation, two were removed from the list, and the remaining three patients were awaiting transplantation at the end of the study. As expected, hospitalization was frequent: there were 89 admissions for 46 patients, most of which were for heart failure. Six patients had ICD firings for ventricular tachycardia. Quality of life 1 month after discharge was significantly improved compared with baseline. Although cost data were unavailable, the estimated cost of home care was only 4.2% of the average daily charge of remaining hospitalized.

In conclusion, home administration of intravenous milrinone therapy was a safe alternative to extended hospitalization in these inotrope-dependent patients awaiting transplant. The authors note that rehospitalization is probable and they recommend that an ICD should be implanted.