Inotropes increase mortality in advanced heart failure
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Transcript of Inotropes increase mortality in advanced heart failure
Inotropes Increase Mortality in Advanced Heart Failure
Sirtaz Adatya, MD Assistant Professor of Medicine
Objectives
1) Inotropes in HF are over Utilized
2) Evidence is sufficient to link inotropes to increased mortality
3) Mechanical Circulatory Support is superior to inotropic therapy
Symptoms No Orthopnea/PND
PCWP ≤16 No exertional Dyspnea
RA<8 No Edema
SBP≥80 JVP<8
Goals of Therapy
Outcomes -Maximizing end organ
perfusion -Quality of Life
-Prevent Readmissions -Decreasing Mortality
Congestion at Rest
No
No
Yes
Yes
Warm and Dry PCW normal CI normal (compensated)
Cold and Dry PCW low/normal CI decreased
Cold and Wet PCW Elevated CI decreased
Warm and Wet PCW elevated CI Normal
Selection for Treatment
Normal SVR-Inotropic Therapy
HI SVR-Vasodilators
Low Perfusion Rest
Stevenson LW. Eur J heart Failure 1999;1:251-257
In Hospital Inotrope Therapy
Real World Data: 65,000 patient cases and 263 hospitals, almost 2 X increase in 6 months mortality
Rose et al. NEJM 2001
Chronic Inotrope Therapy
REMATCH Trial INTREPID Trial
Rogers et al. J Am Coll Cardiol 2007
RRR: 48%, ARR 29% 1 yr mortality
Pulsatile LV device
Novacor Device
Milrinone + B-Blocker ≠ No real DATA Prominent Nuclear Physicist “based on the laws of the Universe adding two opposing forces should result in neutrality”
Inotrope Therapy + B-Blockade