Open AccessInotropes Are Linked to Increased Mortality in Heart Failure
Author(s) -
M. Chadi Alraies,
Bill Tran,
Sirtaz Adatya
Publication year - 2015
Publication title -
the vad journal
Language(s) - English
Resource type - Journals
ISSN - 2378-2706
DOI - 10.14434/vad.v1i0.27904
Subject(s) - inotrope , medicine , heart failure , acute decompensated heart failure , levosimendan , cardiology , cardiac output , intensive care medicine , circulatory system , destination therapy , transplantation , ventricular assist device , hemodynamics
With the advancement of technology and availability of mechanical circulatory support (MCS) devices for the treatment of acute decompensated systolic HF in the 21st century, the role of inotropes is becoming obsolete. Medical therapy for acute decompensated heart failure (HF) has not changed since 1960’s, we still use supplemental oxygen, diuretics, vasodilators and inotropes to improve congestion, cardiac output, end organ perfusion and symptoms related to elevate filling pressures1 . Despite demonstrated improvements in hemodynamics, the uses of inotropes have not demonstrated any improvements in mortality. Mechanical circulatory support (MCS) use is growing rapidly in the USA, in patients with stage D HF both as destination therapy and as a bridge to cardiac transplantation. In both, transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity, quality of life and most importantly mortality have been demonstrated. In this perspective paper we are going to discuss the current lack of evidence for inotropic therapy and the evolving benefit of MCS in end-stage systolic HF patients.