Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology. (10th March 2023)

• Record Type: Journal Article
• Authors: Gustafsson, Finn; Damman, Kevin; Nalbantgil, Sanem; Van Laake, Linda W.; Tops, Laurens F.; Thum, Thomas; Adamopoulos, Stamatis; Bonios, Michael; Coats, Andrew JS; Crespo‐Leiro, Maria G.; Mehra, Mandeep R.; Filippatos, Gerasimos; Hill, Loreena; Metra, Marco; Jankowska, Ewa; de Jonge, Nicolaas; Kaye, David; Masetti, Marco; Parissis, John; Milicic, Davor; Seferovic, Petar; Rosano, Giuseppe; Ben Gal, Tuvia
• Is Part Of: European journal of heart failure. Volume 25:Number 4(2023)
• Page Start: 457
• Page End: 468
• Publication Date: 2023-03-10
• Subjects: Inotrope -- Advanced heart failure -- Cardiorenal syndrome -- Mechanical circulatory support -- Palliation; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2814
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline‐directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end‐of‐life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support).