Inotropic Therapy for Heart Failure — An Unfulfilled Promise

Abstract

MOST reports on clinical trials published in the Journal carry an optimistic message. The new treatment assessed in the trial is usually found to be superior to, or at least as good as, conventional therapy for the condition. In this issue of the Journal, by contrast, Packer et al.¹ report a discouraging result from the Prospective Randomized Milrinone Survival Evaluation (PROMISE). This trial has shown unambiguously that the use of milrinone, an inotropic agent and vasodilator, to treat advanced heart failure is associated with an increase in mortality of about 30 percent. This disturbing finding is likely to influence . . .