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

Authors :
Rossinen J
Harjola VP
Siirila-Waris K
Lassus J
Melin J
Peuhkurinen K
Nieminen MS
Source :
Acute cardiac care [Acute Card Care] 2008; Vol. 10 (4), pp. 209-13.
Publication Year :
2008

Abstract

Background: 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.<br />Aims: 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.<br />Methods: 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.<br />Results: 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.<br />Conclusion: Inotrope administration is a marker of increased mortality in patients with acute heart failure. Still, the use of a single inotrope during hospital stay seems rather safe.

Details

Language :
English
ISSN :
1748-2941
Volume :
10
Issue :
4
Database :
MEDLINE
Journal :
Acute cardiac care
Publication Type :
Academic Journal
Accession number :
18720087
Full Text :
https://doi.org/10.1080/17482940802262376