The use of more than one inotrope in acute heart failure is associated with increased mortality: a multi-centre observational study

Acute Cardiac Care
Juhani RossinenMarkku S Nieminen

Abstract

Although weakly supported by scientific evidence, according to guidelines the use of inotropes in acute heart failure is indicated in the presence of hypoperfusion refractory to fluid resuscitation. We examined the characteristics of the inotrope-treated patients, as well as, their in-hospital mortality. The frequency and dosing of inotropic infusions in patients admitted with acute heart failure was assessed in detail. We included 620 consecutive patients with acute heart failure who were admitted to hospital during three months during spring 2004 in an observational multi-centre study. Of the patients 84 (14%) were treated with inotropes. Dopamine was used in 46 (7%), dobutamine 22 (4%), epinephrine 5 (1%), norepinephrine in 33 (5%), and levosimendan in 44 (7%) cases. The in-hospital mortality was 21% in the inotrope-treated group, and 5% in the control group. The mortality was 7% if only one inotrope was used. The mortality increased in proportion to the number of inotropes used. Lower blood pressure at admission, low ejection fraction, elevated C-reactive protein and cardiac markers correlated with the inotrope administration. Inotrope administration is a marker of increased mortality in patients with acute heart failure. S...Continue Reading

References

Jul 23, 2002·Lancet·F FollathUNKNOWN Steering Committee and Investigators of the Levosimendan Infusion versus Dobutamine (LIDO) Study
Oct 19, 2002·Current Opinion in Critical Care·John A Kellum, Michael R Pinsky
Nov 2, 2002·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Francisco González-VilchezRafael Martín Durán
Oct 6, 2005·JAMA : the Journal of the American Medical Association·Monica R ShahRobert M Califf
Apr 11, 2006·European Heart Journal·Luigi TavazziUNKNOWN Italian survey on Acute Heart Failure Investigators
May 10, 2006·European Heart Journal·Leonardo De LucaMihai Gheorghiade
Sep 27, 2006·European Heart Journal·Markku S NieminenUNKNOWN Heart Failure Association, European Society of Cardiology

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Citations

Jun 19, 2010·Journal of Cardiovascular Translational Research·Daniel G TangHari R Mallidi
Aug 14, 2010·Journal of Receptor and Signal Transduction Research·Gianfranco TonnariniCarlo Cavallotti
Jan 10, 2013·Acta Anaesthesiologica Scandinavica·E WilkmanM Varpula
Nov 30, 2014·Journal of Cardiovascular Pharmacology and Therapeutics·Jacob C JentzerMark Schmidhofer
Dec 14, 2018·Current Cardiology Reviews·Olga N KislitsinaClyde W Yancy
Oct 9, 2012·Dimensions of Critical Care Nursing : DCCN·Soo J Howell
Aug 25, 2020·Current Heart Failure Reports·Jason P GraffagninoKeith M Swetz

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