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Amiodarone Rescue Therapy for Severe Decompensated Heart Failure Initially Unsuitable for β-Blockers

Background: β-Blocker therapy is now standard therapy for patients with stable heart failure; however, fluid-overloaded, New York Heart Association Class IV patients tolerate β-blockers poorly. Amiodarone, a drug with antiadrenergic effects, has been shown to improve survival for patients with heart rates of 90 beats per minute or greater. Methods: We reviewed 26 patients with severe decompensated heart failure who were started on oral amiodarone for heart rate control. β-Blocker titration was attempted when patients became clinically stable. Results: The mean age of the patients was 48.5±17.5 years, and 73% were male. Fifteen patients were New York Heart Association Class IV, and 11 were Class III. Of these, 23 (88%) were fluid-overloaded, and 11 (42%) were on inotropic agents when amiodarone was started. The mean ejection fraction was 16.1 ± 6%. The initial dose of amiodarone was 346 ± 120 mg/day. Twenty (77%) patients were successfully started on β-blockers. At follow-up prior to β-blockers, 20 (77%) patients improved by at least one New York Heart Association class. Heart rate decreased from a mean of 98 ± 15 to 78 ± 13 beats per minute (P < .0001). Echocardiograms were available in 12 patients, with ejection fractions increasing from 16.1 ± 8% to 26.8 ± 13% (P= .004). Conclusions: Amiodarone may be an effective rescue therapy for patients with decompensated heart failure and serve as a bridge to subsequent β-blocker therapy.