Congestive heart failure is a major and growing health care concern worldwide, and mortality in patients with severe
heart failure is high. Few options are available to patients with New York Heart Association class IV
heart failure refractory to oral medical
therapy. Over the last 15-20 years
milrinone, a
phosphodiesterase-III inhibitor, has been used occasionally to treat patients with acute
heart failure and as a bridge to
heart transplantation and, more recently, has been used intermittently or continuously on an outpatient basis. We report a patient with severe, chronic
congestive heart failure, whom we treated successfully with continuous
milrinone infusions as an outpatient. We were able to wean him of the
milrinone after successful up-titration of
carvedilol. Nine months after discontinuation of
milrinone the patient remains stable in New York Heart Association class I on high dose
carvedilol. Research is required to validate the possibility that patients with severe
heart failure may be successfully weaned from
milrinone using
carvedilol and achieve significant improvement of their functional status and quality of life. This may prove to be an effective strategy for the treatment of selected patients with severe, chronic
congestive heart failure. (c)2001 by CHF, Inc.