© 2002 European Society of Cardiology
OPTIME in CHF trial: rethinking the use of inotropes in the management of worsening chronic heart failure resulting in hospitalization
a Division of Cardiology, Northwestern University Medical School 201 E. Huron Street, Galter 10-240, Chicago, IL 60611, USA
b Duke University Medical Center Durham, NC, USA
c Advocate Illinois Masonic Medical Center Chicago, IL, USA
* Corresponding author. Tel.: +1-312-695-0051; fax: +1-312-695-1434 E-mail address: m-gheorghiade@northwestern.edu
Key Words: Chronic heart failure • Milrinone • Hospitalization • OPTIME
Received June 11, 2002; Revised August 9, 2002; Accepted September 17, 2002
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Chronic heart failure (CHF) affects nearly 5 million individuals and causes more than 200 000 deaths each year in the US alone [1]. Worsening CHF is a rapidly growing clinical problem resulting in almost 1 million admissions yearly in the US and it is a marker of poor prognosis [2]. The readmission rates within 6 months after discharge range from 30 to 50% [3].
The hospitalized patients with worsening CHF present with dyspnea and systemic and/or pulmonary congestion as a result of high left ventricular filling pressures due to volume overload. In these patients, the immediate goals are to achieve hemodynamic improvement without causing myocardial injury and to implement life saving therapies that include angiotensin converting enzyme (ACE) inhibitors and beta-blockers.
Randomized evidence for the treatment of worsening CHF resulting in hospitalization was, until very recently, not available. Milrinone, an inotropic agent with