Abstract 14348: Inotrope Use and Outcomes in Hospitalized Heart Failure: Impact of Etiology, Systolic Blood Pressure, and Cardiac Output _ Insights From ESCAPE
Background: Despite limited evidence and mostly negative signals, inotropes are widely used in hospitalized heart failure (HF). We investigated whether HF etiology, systolic blood pressure (SBP), or cardiac index modify the effect of inotropes on outcomes in patients with hospitalized HF.
Methods: Using data from the ESCAPE trial, we examined the association of in-hospital inotrope (dobutamine, milrinone, or dopamine) use with 1) major events by 180 days (death, left ventricular assist device, or cardiac transplantation) and 2) study days alive and out of hospital, in relation to HF etiology, admission SBP, and, in a subset of patients, cardiac index.
Results: Overall, 107/215 (49.8%) ischemic and 87/216 (40.3%) nonischemic patients received inotropes. Events were more frequent among patients who received inotropes, both with ischemic (42.1% vs. 20.4%; P<0.001) and nonischemic (33.3% vs. 16.3%; P=0.003) HF. Risk with inotropes declined over time in ischemic (adjusted HR at 30 days: 4.63; 95% CI: 2.01 to 10.6; P<0.001, HR at 90 days: 2.19; 95% CI: 1.23 to 3.90; P=0.008) but was constant in nonischemic (HR 2.13; 95% CI: 1.16 to 3.94; P=0.015) patients, Fig 1. Admission SBP did not modify risk with inotropes; HR was 3.38 (95% CI: 1.10 to 10.3; P=0.033), 2.56 (95% CI: 1.49 to 4.42; P=0.001), and 1.80 (95% CI: 0.80 to 4.09; P=0.16) in patients with SBP <90, 90-109, and ≥110 mmHg, respectively, Fig 2. Cardiac index (N=196) did not modify risk with inotropes. Inotrope use was associated with fewer study days alive and out of hospital in all subgroups.
Conclusion: In hospitalized advanced HF, inotrope use is associated with unfavorable 180-day outcomes regardless of etiology, SBP, or cardiac index.
- © 2013 by American Heart Association, Inc.