Ambulatory Inotrope Infusions in Advanced Heart Failure: A Systematic Review and Meta-Analysis.

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Advanced heart failure (HF) patients may receive ambulatory inotrope infusions.
• Current understanding of the risks and benefits of this therapy is limited.
• Evidence is particularly scarce for palliative use in Stage D HF.

Purpose of the Study:

• To systematically review existing evidence on the risks and benefits of ambulatory intravenous inotrope therapy in advanced heart failure (HF).
• To synthesize data on outcomes such as mortality, hospitalization, and functional class improvement.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (SCOPUS, Web of Science, EMBASE, MEDLINE) up to August 2016.
• Meta-analysis was performed using random effects models for pooled outcomes.
• Included studies comprised 13 randomized controlled trials and 53 observational studies.

Main Results:

• Pooled analysis of 66 studies revealed specific rates for death (4.2/100 person-months), hospitalization (22.2/100 person-months), and central line infections (3.6/100 person-months).
• Inotrope therapy significantly improved New York Heart Association (NYHA) functional class (mean difference 0.60 classes, p=0.001).
• No significant difference in mortality risk was observed between inotrope users and controls (pooled risk ratio 0.68, p=0.16).

Conclusions:

• High-quality evidence for ambulatory inotrope infusions in advanced HF remains limited, especially for palliative care.
• Available data suggest that intravenous inotropes can enhance functional capacity (NYHA class).
• Current evidence indicates that this therapy does not adversely affect overall survival in advanced heart failure patients.