May 16, 2026Journal of the American College of Cardiology
Heart failure etiology and response tomilrinone in decompensated heart failure
Key result
IV milrinone tends to prolong hospitalization in ischemic HF but shorten it in nonischemic HF.
- n=949
Why the study?
Heart failure etiology has prognostic and therapeutic implications, but its relationship to response to inotropic therapy is unknown.
Does intravenous milrinone improve outcomes in patients with decompensated heart failure based on ischemic versus nonischemic etiology?
Population
949 patients with systolic dysfunction and decompensated HF
Comparison
48 to 72 h of intravenous milrinone vs placebo, stratified by etiology
Design
Post-hoc analysis of a randomized controlled trial
Follow-up
60 days
Authors
Discussion
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Implication
Etiology may modify milrinone response in decompensated HF; challenges uniform inotrope use and leaves open etiology-specific trials.
Key Points
- This study aims to evaluate how the cause of heart failure affects the treatment response to milrinone in patients with decompensated heart failure.
- Study involved 949 patients with systolic dysfunction and decompensated heart failure.
- Patients were randomized to receive milrinone or placebo for 48 to 72 hours.
- Primary endpoint measured was days hospitalized from cardiovascular causes within 60 days.
- Ischemic patients had 13.0 days in hospital compared to 11.7 days for nonischemic patients (p = 0.2).
- Sixty-day mortality was higher in ischemic patients at 11.6% compared to 7.5% for nonischemic (p = 0.03).
- Milrinone had worse outcomes for ischemic patients (13.6 days) compared to placebo (12.4 days, p = 0.055), while nonischemic patients saw improved outcomes (10.9 vs. 12.6 days).
Study Design
Type
RCT (n=949)
Structured PICO
Does intravenous milrinone improve outcomes in patients with decompensated heart failure based on ischemic versus nonischemic etiology?
P
Population
949 patients with systolic dysfunction and decompensated heart failure
I
Intervention
Intravenous milrinone for 48 to 72 hours
C
Comparator
Placebo
O
Outcome
Days hospitalized from cardiovascular causes within 60 dayshard clinical
In decompensated heart failure, intravenous milrinone may be harmful in patients with ischemic etiology but potentially beneficial in those with nonischemic etiology.
Limitations
- Post-hoc analysis
- post-hoc analysis
Cite This Study
Felker et al. (2003) conducted an RCT in Decompensated heart failure (n=949). Milrinone vs. Placebo was evaluated on Days hospitalized from cardiovascular causes within 60 days. Intravenous milrinone showed a bidirectional effect, tending to increase cardiovascular hospital days in ischemic HF (13.6 vs 12.4) but decrease them in nonischemic HF (10.9 vs 12.6).