Photo Credit: Studio Romantic

The following is a summary of “Incidence of Clinically Significant Ventricular Arrhythmias in Patients on Home Inotrope Infusion in the Contemporary Era,” published in the March 2025 issue of American Journal of Cardiology by Fakess et al. 

Heart failure (HF) remains a major public health concern, affecting approximately 6.2 million individuals in the United States. In patients with advanced or end-stage HF, continuous intravenous inotropic therapy—often administered in outpatient settings—is commonly used either as a palliative measure or as a bridge to advanced therapies such as transplant or mechanical circulatory support. Despite widespread use, the incidence of hemodynamically significant ventricular arrhythmias (VA) in this population under current medical management remains insufficiently characterized. 

This retrospective study aimed to quantify the incidence of clinically significant VA events—including sustained ventricular arrhythmias, syncope, ICD therapy, and cardiac arrest—among patients with end-stage HF receiving home inotropic therapy. A total of 438 consecutive patients (mean age 68.0 ± 13.7 years; 72.4% male) who were prescribed outpatient intravenous inotropes—either milrinone (n = 353) or dobutamine (n = 85)—were analyzed over a mean follow-up period of 9.3 ± 11.6 months. Patient records were reviewed for documented VA-related events and corresponding ICD interrogation data. The overall incidence of clinically meaningful VA events was 5.66 per 100 person-months (95% [CI], 4.97–6.44), with a higher rate observed in patients receiving milrinone (6.04 events per 100 person-months) compared to those on dobutamine (3.79 events per 100 person-months). Subgroup analyses revealed additional risk stratification insights. 

Patients with nonischemic cardiomyopathy experienced a significantly higher rate of VA events compared to those with ischemic cardiomyopathy, with a rate difference of 2.54 events per 100 person-months (95% CI, -1.09 to 3.99; P < 0.001). Furthermore, patients receiving concurrent antiarrhythmic therapy exhibited a markedly higher VA event rate than those not on antiarrhythmics, with an incidence difference of 5.65 events per 100 person-months (95% CI, 3.71–7.59; P < 0.001). These findings suggest that while overall VA event rates among patients on home inotropic support remain relatively low in the contemporary treatment era, specific subgroups—particularly those treated with milrinone, diagnosed with nonischemic cardiomyopathy, or managed with antiarrhythmic medications—may carry a higher arrhythmic burden. This underscores the importance of careful patient selection, risk assessment, and ongoing monitoring when considering prolonged inotrope therapy in outpatient settings. The study contributes valuable contemporary data that may inform clinical decision-making and guide risk mitigation strategies for patients with advanced HF receiving home inotropic support.

Source: ajconline.org/article/S0002-9149(25)00218-8/fulltext