Intérêt de la dobutamine à domicile dans l'insuffisance cardiaque sévère

Heart failure is a leading cause of hospitalisation and rehospitalisation of the elderly population, which leads to significant financial burden. In this epidemiological context, a major challenge is to know the impact of continuous intravenous aminergic treatment at home on morbidity, mortality, and economic costs. After the description of a clinical case, the benefits and the use of dobutamine at home in severe heart failure are explored in the scientific literature, particularly its impact on life expectancy, patient's functional capacity and health care financial costs. As a large, prospective, double-blind, randomized, controlled trial is missing, it is impossible to demonstrate the efficacy of this treatment on functionality, mortality and financial costs. However, clinical experience demonstrated that continuous infusion of dobutamine improves the functional capacity of patients with severe heart failure. Regarding life expectancy, there is a trend of increased mortality with home intravenous dobutamine administration in the population with severe heart failure excluded from transplantation. A primary objective of the home intravenous administration of dobutamine is to allow the patient to stay at home as long as possible. Despite a low benefit/risk ratio, the continuous intravenous administration of dobutamine at home seems justified in patients with NYHA class IV heart failure, unresponsive to the conventional therapy, excluded from transplantation and ventricular device, and having a poor mid-term prognosis (less than 6 months).