Ambulatory milrinone in advanced heart failure: a single-center comparison of continuous and intermittent infusion strategies
A Rioux, E Voisine, S Berube, L P Paquette, D Belzile, P Y Turgeon, K O'Connor, B Labbe, M Bernier, A B Shearer, C Bourgault, J Morin, M SenechalAbstract
Background
Outpatient management of advanced heart failure is challenging. Intravenous inotropes, administered intermittently or continuously, may serve as destination therapy or as a bridge to definitive treatment in selected patients.
Purpose
This study aims to evaluate the efficacy and safety of ambulatory milrinone in advanced heart failure and compare continuous versus intermittent administration to guide patient selection and tailored therapy.
Methods
We retrospectively studied patients receiving milrinone at a specialized heart failure clinic in a tertiary center. Patients were stratified by intermittent or continuous infusion. Baseline demographic, clinical, and biochemical characteristics were collected. Outcomes included death, hospitalizations for heart failure (HHF), New York Heart Association (NYHA) functional class, significant ventricular arrhythmias, and hospitalizations for catheter-related infection.
Results
Between 2009 and 2025, 115 patients were discharged on ambulatory milrinone—35 (30%) on continuous and 80 (70%) on intermittent infusion—for a mean of 522 ± 744 days. The cohort was predominantly male (82%) with a mean age of 68 years and LVEF of 19 ± 10%. Most were on destination therapy (75%), with 41% on therapy ≥1 year and 16% ≥3 years. Heart failure hospitalization rate was 4.7 per 100 patient-months, slightly higher in the intermittent group (5.8 vs. 4.0; p = 0.12). NYHA improvement was sustained at 1 year in continuous infusion patients (p < 0.001) but not beyond 3 months in the intermittent group. Continuous infusion patients were younger, had more severe systolic dysfunction, fewer comorbidities, and lower mortality. Significant ventricular arrhythmias (8%) and catheter-related infection hospitalizations (4%) were rare.
Conclusion
Long-term ambulatory milrinone is feasible and improves functional status in advanced heart failure, with benefits sustained at 1 year in selected continuous-infusion patients and low complication rates. Heart failure hospitalizations were lower in our cohort than in previously described advanced heart failure cohorts without ambulatory milrinone.NYHA status evolution (continuous infusion)Inotropic support outcomes