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Risk Stratification in PAH Pulmonary hypertension due to left heart disease Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review Pulmonary Hypertension Caused by a Coconut Left Atrium Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study The association between body mass index and obesity with survival in pulmonary arterial hypertension Genetic analyses in a cohort of 191 pulmonary arterial hypertension patients Levosimendan Improves Hemodynamics and Exercise Tolerance in PH-HFpEF: Results of the Randomized Placebo-Controlled HELP Trial Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension
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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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