August 14, 2026Journal of the American College of Cardiology308 citationsOpen Access
Survival of patients with severe congestive heart failure treated with oral milrinone
Key Result
Long-term oral milrinone therapy in patients with severe congestive heart failure was associated with a 63% mortality rate at 1 year, showing no evidence of improving baseline mortality.
Key Points
- To evaluate the safety, clinical efficacy, and long-term survival outcomes of oral milrinone therapy in patients with severe congestive heart failure refractory to standard treatment.
- Followed 100 patients with severe, refractory congestive heart failure over a 2.5-year period.
- Administered long-term oral milrinone at an initial dose of 27 ± 8 mg/day and assessed clinical status, functional class, and hemodynamic variables.
- At 1 month, 51% of 94 evaluated patients improved by at least one NYHA functional class, with adverse effects in 11% and drug withdrawal in 4%.
- Life table analysis demonstrated cumulative mortality rates of 39% at 6 months and 63% at 1 year of therapy.
- Multivariate analysis identified lower baseline cardiac index and lower aortic systolic pressure as the most significant predictors of 6-month mortality.
Study Design
Type
Cohort (n=100)
Structured PICO
Does long-term oral milrinone therapy improve survival and symptoms in patients with severe congestive heart failure refractory to conventional therapy?
P
Population
100 patients with severe congestive heart failure refractory to conventional therapy, evaluated over a 2.5-year period.
E
Exposure
Long-term oral milrinone therapy (initial dose 27 +/- 8 mg/day)
O
Outcome
Mortality at 6 months and 1 yearhard clinical
Oral milrinone provides early symptomatic relief in severe heart failure but does not appear to improve the high underlying mortality rate.
Abstract
The safety and efficacy of long-term oral milrinone therapy were evaluated over a 2 1/2 year period in 100 patients who had severe congestive heart failure despite conventional therapy. Long-term oral milrinone therapy (27 +/- 8 mg/day initial dose) was well tolerated; drug-related side effects occurred in only 11% of patients and led to drug withdrawal in only 4% of patients. Of 94 patients evaluated after 1 month of therapy, 51% had improved by at least one New York Heart Association functional class. Despite hemodynamic and clinical improvements, life table analysis showed a 39% mortality rate at 6 months and a 63% mortality rate at 1 year of therapy. Characteristics at study entry that predicted death within 6 months included more advanced functional class, impaired renal function, lower right ventricular ejection fraction, presence of nonsustained ventricular tachycardia on 24 hour ambulatory electrocardiography, more impaired baseline hemodynamic function and absence of clinical improvement after 1 month of milrinone therapy. Multivariate analysis selected lower baseline cardiac index and aortic systolic pressure as the most significant variables in predicting death; patients who died of progressive heart failure had less frequent use of antiarrhythmic drugs and greater increases in furosemide and milrinone doses during long-term follow-up than did those who died suddenly. Thus, although milrinone is well tolerated and produces early symptomatic benefits in approximately half of patients with congestive heart failure refractory to conventional therapy, there is no evidence that it improves the high baseline mortality in this disorder.