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Inotropic therapy for heart failure: an evidence-based approach
1Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. felke001@onyx.dcri.duke.edu
American Heart Journal
|August 30, 2001
Summary
Long-term use of positive inotropes for heart failure increases mortality and is not routinely indicated. Temporary use may be appropriate for specific acute decompensations or palliative care in end-stage heart failure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Positive inotropes offer hemodynamic benefits in acute and chronic heart failure.
- Long-term inotropic therapy is associated with increased mortality in heart failure patients.
- Despite risks, inotropes are commonly used in heart failure management.
Purpose of the Study:
- To review evidence on short- and long-term inotrope use in heart failure.
- To evaluate the impact of inotropes on mortality and quality of life.
- To assess the appropriateness of inotropes in various heart failure scenarios.
Main Methods:
- Review of available data on inotrope use in heart failure.
- Emphasis on high-quality evidence from randomized trials.
- Analysis of data addressing clinical endpoints.
Main Results:
- Long-term inotropic therapy negatively impacts survival in heart failure.
- Evidence for improved quality of life with inotropic therapy is mixed.
- Lack of high-quality randomized evidence for use in acute decompensations or as a bridge to transplant.
Conclusions:
- Routine use of inotropes is not indicated for acute or chronic heart failure.
- Potential uses include temporary treatment for acute decompensations or as a bridge to transplant.
- Palliative use in end-stage heart failure and development of novel treatments are discussed.