What question did this study set out to answer?

To systematically review and synthesize current evidence on milrinone therapy in acute heart failure, focusing on clinical outcomes, hemodynamic effects, and safety considerations.

January 10, 2026Open Access

Milrinone Therapy in Acute Heart Failure: Clinical Evidence, Hemodynamic Effects, and Safety Considerations

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Key result

Milrinone improves cardiac index in AHF but shows no mortality or rehospitalization benefit over dobutamine.

Why the study?

Despite decades of use, evidence regarding the comparative effectiveness, hemodynamic benefits, and safety profile of milrinone in acute heart failure continues to evolve.

Does intravenous milrinone improve clinical outcomes and hemodynamics in adult patients with acute heart failure?

Population

Patients with acute heart failure, acute decompensated heart failure, or cardiogenic shock

Comparison

Milrinone vs dobutamine or other therapies

Design

Systematic review

Authors

JCJorge David Villanueva CuevasInstitute for Social Security and Services for State Workers

Discussion

Member takes

Implication

Hemodynamic gains support targeted milrinone use in low-output acute heart failure; confirms no mortality or rehospitalization advantage over dobutamine.

Key Points

To systematically review and synthesize current evidence on milrinone therapy in acute heart failure, focusing on clinical outcomes, hemodynamic effects, and safety considerations.
Evaluated literature including randomized controlled trials (e.g., OPTIME-CHF, DOREMI), observational cohorts, meta-analyses, and contemporary guidelines (AHA/ACC/HFSA 2022; ESC 2021–2023).
Included studies investigating milrinone administration in acute heart failure, acute decompensated heart failure, and cardiogenic shock.
Synthesized findings narratively across endpoints including mortality, rehospitalization, hemodynamic response, adverse events, and comparative efficacy against dobutamine.
Comparative trials demonstrate milrinone improves cardiac index and reduces pulmonary capillary wedge pressure, supporting its use in low-output acute heart failure.
Major clinical outcomes, including mortality and rehospitalization, show no consistent superiority over dobutamine, with the randomized DOREMI trial demonstrating clinical equipoise in cardiogenic shock.
Safety evaluations identify elevated risks of arrhythmias and hypotension, particularly among patients with renal impairment or advanced shock.

Structured PICO

Does intravenous milrinone improve clinical outcomes and hemodynamics in adult patients with acute heart failure?

Population

Adult patients with acute heart failure, acute decompensated heart failure, or cardiogenic shock

Intervention

Intravenous milrinone

Comparator

Dobutamine, standard therapy, or no inotropic support

Outcome

Mortality, rehospitalization, cardiac index, systemic and pulmonary vascular resistance, renal function, hypotension, arrhythmias, and adverse effects

Milrinone provides meaningful hemodynamic improvement in acute heart failure but does not consistently improve survival or rehospitalization compared to dobutamine, and carries risks of hypotension and arrhythmias.

Limitations

Heterogeneity in study populations, renal function, baseline hemodynamic status, and severity of shock
Confounding and selection bias in observational studies

Cite This Study

Jorge David Villanueva Cuevas (2026) studied this question. Milrinone improves cardiac index and reduces pulmonary pressures in acute heart failure but shows no consistent benefit in mortality or rehospitalization over dobutamine.

synapsesocial.com/papers/696321d091e05aa366cb80f8 https://doi.org/10.5281/zenodo.18169191

Topics

Heart failure HFrEF treatment

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Implication

Hemodynamic gains support targeted milrinone use in low-output acute heart failure; confirms no mortality or rehospitalization advantage over dobutamine.

Milrinone Therapy in Acute Heart Failure: Clinical Evidence, Hemodynamic Effects, and Safety Considerations

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Milrinone Therapy in Acute Heart Failure: Clinical Evidence, Hemodynamic Effects, and Safety Considerations

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider