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Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine - The ROPA-DOP Trial 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) Association of Reduced Apical Untwisting With Incident HF in Asymptomatic Patients With HF Risk Factors Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women Proteomics to Improve Phenotyping in Obese Patients with Heart Failure with Preserved Ejection Fraction Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Criteria for Iron Deficiency in Patients With Heart Failure
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Original ResearchVolume 6, Issue 9, September 2018

JOURNAL：JACC: Heart Failure Article Link

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

T Nizamic, MH Murad, LA Allen et al. Keywords: death; hospitalization; palliative care; risk; transplant

ABSTRACT

OBJECTIVES - This study sought to systematically review the available evidence of risks and benefits of ambulatory intravenous inotrope therapy in advanced heart failure (HF).


BACKGROUND - Ambulatory inotrope infusions are sometimes offered to patients with advanced Stage D HF; however, an understanding of the relative risks and benefits is lacking.

METHODS - On August 7, 2016, we searched SCOPUS, Web of Science, Ovid EMBASE, and Ovid MEDLINE for studies of long-term use of intravenous inotropes in outpatients with advanced HF. Meta-analysis was performed using random effects models.

RESULTS - A total of 66 studies (13 randomized controlled trials and 53 observational studies) met inclusion criteria. Most studies were small and at high risk for bias. Pooled rates of death (41 studies), all-cause hospitalization (15 studies), central line infection (13 studies), and implantable cardioverter-defibrillator shocks (3 studies) of inotropes were 4.2, 22.2, 3.6, and 2.4 per 100 person-months follow-up, respectively. Improvement in New York Heart Association (NYHA) functional class was greater in patients taking inotropes than in controls (mean difference of 0.60 NYHA functional classes; 95% confidence interval [CI]: 0.22 to 0.98; p = 0.001; 5 trials). There was no significant difference in mortality risk in those taking inotropes compared with controls (pooled risk ratio: 0.68; 95% CI: 0.40 to 1.17; p = 0.16; 9 trials). Data were too limited to pool for other outcomes or to stratify by indication (i.e., bridge-to-transplant or palliative).

CONCLUSIONS - High-quality evidence for the risks and benefits of ambulatory inotrope infusions in advanced HF is limited, particularly when used for palliation. Available data suggest that inotrope therapy improves NYHA functional class and does not impact survival.
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