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dc.contributor.authorSharma, Toishi
dc.contributor.authorBalakumaran, Kathir
dc.contributor.authorTandon, Varun
dc.contributor.authorShah, Nihar
dc.contributor.authorArora, Sabeena
dc.identifier.citationUniv Arizona, Internal Med, Coll Meden_US
dc.description.abstractMilrinone is a phosphodiesterase three inhibitor used as an inotrope in patients with advanced heart failure with reduced ejection fraction (HFrEF). Its action is independent of beta-receptor stimulation, which makes it preferable in patients who are on beta blockers as part of a guideline-directed neurohormonal blockade. There have been numerous studies evaluating the risks, benefits, and mortality associated with milrinone in the management of chronic heart failure patients. Time and again, there has been concern regarding the undesirable outcomes associated with it, including higher mortality and cardiac arrhythmias. Additionally, it has been difficult to determine whether milrinone or disease progression is responsible for adverse outcomes and mortality. In light of such discrepancy, the selection of patients for milrinone remains challenging. We hypothesized that there are underlying patient characteristics that influence the response to milrinone and may predict milrinone's adverse outcomes in spite of milrinone. A retrospective study review of 10 patients on palliative milrinone was conducted to identify these factors with a mean follow-up of 36 months. During the study period, four of 10 patients died. These four patients were on milrinone for a mean of 11.5 months. The attributes of the survivors compared to the deceased included lower age at start of therapy (67.5 vs 79 y), female gender (66% vs 33%), non-ischemic cardiomyopathy (33% vs 50%), associated diagnosis of atrial fibrillation/flutter(50% vs 25%), hyperlipidemia (66% vs 50%), or anemia (83% vs 75%), presence of chronic resynchronization therapy (CRT) (66% vs 25%), and implantable cardioverter-defibrillator (ICD) (16% vs 0%), as well as lower sodium (136 vs 140 mEq), chloride (101.5 vs 104.5 mEq), potassium (4.07 vs 4.23 mEq), and creatinine (1.3 vs 1.8 mg/dL) Conversely, the deceased patients were more likely to have coronary artery disease (75% vs 33%), diabetes mellitus (50% vs 16%), hypertension (100% vs 83%), chronic kidney disease (75% vs 66%), peripheral vascular disease (25% vs zero), higher pulmonary artery pressures (54 vs 50.5%), and history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) (50% vs 16%). These trends exhibit patient characteristics that may predict better outcomes on long-term milrinone although larger studies are needed to assess the statistical significance of these findings.en_US
dc.publisherCUREUS INCen_US
dc.rights© Copyright 2020 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.en_US
dc.subjectlong-term outcomeen_US
dc.subjectprognostic factorsen_US
dc.titlePatient Attributes Associated With Better Long-Term Outcomes on Palliative Milrinoneen_US
dc.contributor.departmentUniv Arizona, Internal Med, Coll Meden_US
dc.description.noteOpen access journalen_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at
dc.eprint.versionFinal published versionen_US

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© Copyright 2020 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.
Except where otherwise noted, this item's license is described as © Copyright 2020 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0.