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


OBJECTIVE
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.


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.


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.


CONCLUSIONS
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.
Rossinen
Juhani
J
Divisions of Emergency Care and Cardiology. Department of Internal Medicine, Helsinki, Finland. juhani.rossinen@fimnet.fi
Harjola
Veli-Pekka
VP
Siirila-Waris
Krista
K
Lassus
Johan
J
Melin
John
J
Peuhkurinen
Keijo
K
Nieminen
Markku S
MS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002395:Catecholamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000077464:Simendan; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D002395:Catecholamines; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan