ABSTRACT
Although heart transplantation and mechanical circulatory support are effective therapies for patients with advanced heart failure (HF), many patients are ineligible due to co-morbidities. Continuous home intravenous with positive inotropes such as milrinone are used in these patients to improve quality of life. We hypothesized that, unlike previous studies with oral milrinone, a slow-release formulation that provides stable lower plasma levels may be better tolerated and provide symptomatic benefit. Accordingly, we developed an extended release milrinone formulation (CRD-102) and evaluated its effects in 26 patients with no-option Stage D HF. One month after open-label therapy there were significant improvements in NYHA class, Minnesota Living with Heart Failure score and 6-minute walk distance. There was no evidence of hypotension or increased arrhythmic burden. In conclusion, the present study demonstrates evidence of beneficial actions of extended release milrinone in advanced HF. Longer-term randomized clinical trial data are required.
Subject(s)
Cardiotonic Agents/administration & dosage , Heart Failure/drug therapy , Milrinone/administration & dosage , Aged , Animals , Delayed-Action Preparations , Female , Humans , Male , Quality of Life , Treatment OutcomeABSTRACT
The treatment of dehydration in older adults admitted from residential care to an acute hospital setting may lead to haemodynamic stability. There is however an increased risk for short or long term alterations in physiological, cognitive and psychological status and ultimately, decreased quality of life. Such acute care admissions could be decreased where preventative strategies tailored to address individual risk factors are combined with more frequent assessment of the degree of hydration. The questionable reliability of assessment criteria in older adults increases the need to use multiple signs and symptoms in the identification and differentiation of early and late stages of dehydration. This article reviews various risk factors, explores the reliability of clinical signs and symptoms and reinforces the need to use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of dehydration. Specific strategies to maintain hydration in older adults are also identified.
