Prolonged dobutamine infusion in patients with systolic heart failure

Zatajivanje srca predstavlja značajan uzrok mortaliteta i morbiditeta u zemljama modernog svijeta. Iako medicina napreduje svakim danom i u zadnjih je stotinjak godina doživjela dramatičan napredak, kako na tehnološkoj razini, tako i u preventivnom djelovanju i otkrivanju novih lijekova, prevalencija je i dalje u porastu. Porast prevalencije zatajivanja srca se može tumačiti starenjem stanovništva, poglavito u razvijenim zemljama. Tako u Europi prevalencija zatajivanja srca bilo kojeg uzroka iznosi 2%, dok u osoba starijih od 65 godina doseže i do 10% (Vrhovac et al. 2008). Podaci za prevalenciju zatajivanja srca u SAD za 2009. godinu iznose 5,8 milijuna novooboljelih (Tacon et al. 2012). Zatajivanje srca ne predstavlja jedinstvenu bolest per se, nego klinički sindrom koji može imati različiti broj uzroka: bolesti miokarda, bolesti perikarda, bolesti valvularnog aparata, bolesti endokarda, bolesti sustava za provođenje itd. Osim toga, prema brzini nastupa kliničke manifestacije bolesti, može biti akutnog i kroničnog tijeka. Bolest ima progresivan tijek i znatno remeti kvalitetu života i funkcionalnu sposobnost bolesnika. Gledajući financijski značaj i izdvajanja za oboljele, u razvijenim zemljama se za ovu bolest izdvaja oko 2% ukupnog novca za zdravstvo (Vrhovac et al. 2008). Liječenje zatajivanja srca sastoji se od nefarmakoloških i farmakoloških mjera te transplantacije u terminalnim stadijima bolesti. Djelovanje na uzroke ove bolesti, njihovo sprječavanje i rano otkrivanje, predstavlja jedan oblik primarne prevencije koja je gotovo jednake važnosti kao i samo liječenje razvijene bolesti. Primarna prevencija, osim što otkriva bolesnike u ranoj fazi oboljenja koji može dovesti do zatajivanja srca i tako utječe na životni vijek bolesnika, također smanjuje financijska izdavanja države smanjivanjem broja hospitalizacija zbog zatajivanja srca (De Vore et al. 2016). Brojni su lijekovi za liječenje ove bolesti: ACE inhibitori, antagonisti aldosterona, antagonisti AT-1 receptora, β-blokatori, diuretici te inotropi, u koje spada i dobutamin koji je predmet ovog diplomskog rada. Kao krajnja terapija za bolesnike u terminalnoj fazi bolesti preostaje transplantacija srca. Iako se uz dobutamin veže povećan mortalitet kao rezultat njegove primjene, osobito u usporedbi s drugim lijekovima za liječenje zatajivanja srca, što potvrđuju rezultati studija navedenih u ovom radu, dobutamin i dalje zauzima važno mjesto u liječenju bolesnika sa zatajivanjem srca i ostaje za sada gotovo neizbježan dio terapije.Heart failure poses as a significant cause of mortality and morbidity in modern world countries. Although medicine is making new breakthroughs every day, and has experienced dramatic improvement over the last hundred years, regarding the technological aspect as well as preventative actions and new drugs discoveries, prevalence rates are still ascending. The increase of heart failure prevalence can be explained by the fact the general population is getting older, especially in more developed countries. Thus, heart failure rate of any cause in Europe is around 2%, but it goes up to 10% in population above 65 years of age (Vrhovac et al. 2008). Prevalence rates regarding the USA in 2009 add up to 5.8 million new cases of heart failure (Tacon et al. 2012). Heart failure does not represent a unique disease per se, but a clinical syndrome with a number of causes: myocardial diseases, pericardial diseases, valve disorders, endocardia diseases, conduction system disorders and so on. Besides that, regarding the rate of its clinical manifestation, the disease can be of acute or chronic course. Heart failure has a progressive course and it significantly disrupts the quality of patients’ life and their functional ability. Taking into account the financial significance and expense for the ill, up to 2% of total healthcare funds are allocated to the aforementioned disease treatment (Vrhovac et al. 2008). Heart failure treatment consists of non-pharmacological and pharmacological measures, as well as heart transplantation in terminal stages. Managing the causes of the disease, their eradication and early detection, represent a form of primary prevention which is nearly as significant as the very treatment of the established disease. Except for detecting patients in an early stage of a disease consequently leading to heart failure and therefore affecting their life span, primary prevention reduces financial expenses due to decreasing heart failure rates and consequently the need for hospitalization (De Vore et al. 2016). There are a number of drugs used for heart failure treatment: ACE inhibitors, aldosterone inhibitors, AT-2 receptor antagonists, β-blockers, diuretics and inotropic drugs, including dobutamine, which is in fact the main topic of this thesis. Heart transplantation remains as the last resort for patients in terminal stages. Although dobutamine treatment is related to an increased mortality rate, especially compared to other drugs used in heart failure treatment, which has been affirmed in results of studies elaborated in this thesis, it still represents an important part in treating patients with heart failure and remains almost inevitable treatment