Outpatient dobutamine for refractory congestive heart failure: advantages, techniques, and results.

Patients with refractory, end-stage congestive heart failure awaiting heart transplantation may be treated efficaciously with intermittent infusions of dobutamine given on an outpatient basis. The treatment appears to be well tolerated. Nevertheless, careful attention to electrolyte balance and arrhythmia control is essential to minimize the risk of sudden death. Use of a tunneled subcutaneous catheter essentially eliminates the risk of infection associated with this type of delivery system. Patients who have worsening heart failure while receiving dobutamine as outpatients should be fitted for a mechanical assist device before complications develop that may contraindicate transplantation.