Abstract
Background
Outpatient calcitrope infusions—that is, the cardiac inotropes milrinone and dobutamine—are
often used for bridge to transplantation and palliation in advanced heart failure,
but few data exist about the real-world use of these agents.
Methods and Results
We used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid
insurance claims of approximately 280 million people (2012–2020) to determine the
incidence and characteristics of ambulatory calcitrope use. Demographics were calculated,
including geographic densities at the metropolitan statistical area level. A population
projection normalized for age, sex, and location was extrapolated to the total US
population. Ambulatory dispensing of milrinone was found in 10,533 outpatients, 1867
in 2019. Ambulatory dobutamine use was found in 4967 outpatients, 836 in 2019. The
2019 total US projection was 3411 for milrinone and 1281 for dobutamine. The mean
age was 62 years for milrinone and 68 for dobutamine. Males represented 70% of use.
There were differences between drugs in geographic distribution, with more milrinone
use in the Northeast and South and more dobutamine use in the Midwest. Duration of
use was 4.6 ± 7.2 months for milrinone and 1.8 ± 4.0 months for dobutamine. Of the
patients receiving milrinone, 30.6% subsequently underwent cardiac transplantation
or left ventricular assist device placement, whereas 10% receiving dobutamine went
on to advanced therapies. Less than 0.5% of patients received calcitropes while enrolled
in hospice care.
Conclusions
More than 4000 patients receive outpatient infusion of calcitropes annually in the
outpatient setting. Men are much more likely to receive these medications. A minority
of the use is as a bridge to advanced therapies. Geographic variability in use suggests
better evidence and consistent guidelines may be helpful.
Key Words
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References
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Article info
Publication history
Published online: July 12, 2021
Accepted:
June 24,
2021
Received in revised form:
June 23,
2021
Received:
June 21,
2021
Identification
Copyright
Published by Elsevier Inc.
