Amiodarone Rescue Therapy for Severe Decompensated Heart Failure Initially Unsuitable for β-Blockers
| Autor: | J. Thomas Heywood, Kanu Chatterjee, Theresa De Marco, Lee Ann Hawkins, Bonnie Huiskes, Daniel C. Choo, Jennifer Jones, Sharon Fabbri |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male Inotrope medicine.medical_specialty Beats per minute Initial dose Adrenergic beta-Antagonists Amiodarone 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences 0302 clinical medicine Heart Rate Rescue therapy Internal medicine Heart rate medicine Humans Pharmacology (medical) 030212 general & internal medicine Aged Heart Failure Pharmacology Ejection fraction business.industry Stroke Volume Middle Aged medicine.disease Echocardiography Heart failure Cardiology Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents medicine.drug |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 1940-4034 1074-2484 |
| DOI: | 10.1177/107424840300800303 |
| Popis: | Background: β-Blocker therapy is now standard therapy for patients with stable heart failure; however, fluid-overloaded, New York Heart Association Class IV patients tolerate β-blockers poorly. Amiodarone, a drug with antiadrenergic effects, has been shown to improve survival for patients with heart rates of 90 beats per minute or greater. Methods: We reviewed 26 patients with severe decompensated heart failure who were started on oral amiodarone for heart rate control. β-Blocker titration was attempted when patients became clinically stable. Results: The mean age of the patients was 48.5±17.5 years, and 73% were male. Fifteen patients were New York Heart Association Class IV, and 11 were Class III. Of these, 23 (88%) were fluid-overloaded, and 11 (42%) were on inotropic agents when amiodarone was started. The mean ejection fraction was 16.1 ± 6%. The initial dose of amiodarone was 346 ± 120 mg/day. Twenty (77%) patients were successfully started on β-blockers. At follow-up prior to β-blockers, 20 (77%) patients improved by at least one New York Heart Association class. Heart rate decreased from a mean of 98 ± 15 to 78 ± 13 beats per minute (P < .0001). Echocardiograms were available in 12 patients, with ejection fractions increasing from 16.1 ± 8% to 26.8 ± 13% (P= .004). Conclusions: Amiodarone may be an effective rescue therapy for patients with decompensated heart failure and serve as a bridge to subsequent β-blocker therapy. |
| Databáze: | OpenAIRE |
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