title: Treatment with inotropes and related prognosis in acute heart failure: contemporary data from the Italian Network on Heart Failure (IN-HF) Outcome registry.
abstract: BACKGROUND
  In the recent Italian Network on Heart Failure (IN-HF) Outcome registry, including 1,855 patients with acute heart failure (AHF), we reviewed the use of inotropes and their prognostic implication on in-hospital and 12-month mortality.
  
  
  METHODS
  IN-HF Outcome is a prospective, multicenter, observational, study involving 61 Italian cardiology centers. AHF patients have been enrolled over a 2-year period and followed-up for 1 year. Inotropes were used in 360 patients (19.4%).
  
  
  RESULTS
  Patients who received inotropes had a more severe clinical and hemodynamic profile than those who did not and exhibited a significantly higher rate of in-hospital (21.4% vs 2.7%, p < 0.01) and 1-year (50.6% vs 17.7%, p < 0.01) mortality. At entry, systolic blood pressure (SBP) was ≤ 110 mm Hg in 58%, 111 to 130 mm Hg in 24.5%, and > 130 mm Hg in 17.5%. Multivariable analyses showed use of inotropes was the strongest predictor of all-cause death. These data were confirmed by propensity score analyses. According to SBP at entry, the 2 groups with SBP > 110 mm Hg who took inotropes, despite a more favorable clinical profile, exhibited a similar worse prognosis, particularly at 1 year: 56.3% (≤ 110 mm Hg), 43.7% (111-130 mm Hg), and 40.3% (>130 mm Hg) vs 17.7%.
  
  
  CONCLUSIONS
  Inotropes were used in nearly 20% of the patient admitted for AHF, and this treatment was associated with a short-term to medium-term poor prognosis. An inappropriate use of inotropes in patients with normal to high SBP, and presumably preserved cardiac output, may have significantly contributed to affect the all-group outcome.
authors.affiliation: Department of Clinical Cardiology and Heart Failure, Policlinico di Monza, Monza.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.affiliation: Cardiologia 2 Heart Failure and Heart Transplant Program, "A. De Gasperis" Cardiovascular Department, Niguarda Hospital, Milano.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.affiliation: Cardiology, University and Spedali Civili of Brescia, Brescia.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Cardiology Department, Orlandi Hospital, Bussolengo.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Carbonieri
authors.affiliation: Cardiovascular Unit, Azienda Servizi Sanitari n. 1 Triestina, Trieste.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze.
authors.forename: Marco
authors.initials: M
authors.lastname: Gorini
authors.affiliation: Cardiology Department, Ospedali Riuniti Albano-Genzano, Albano Laziale.
authors.forename: Paolo
authors.initials: P
authors.lastname: Midi
authors.affiliation: USC Cardiovascular Medicine, Papa Giovanni XXIII Hospital, Bergamo.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze.
authors.forename: Renato
authors.initials: R
authors.lastname: Urso
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze. Electronic address: centrostudi@anmco.it.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents
keywords: IN-HF Outcome registry; acute heart failure; death; inotropes; prognosis; systolic blood pressure