Andrea Mortara1, Fabrizio Oliva2, Marco Metra3, Emanuele Carbonieri4, Andrea Di Lenarda5, Marco Gorini6, Paolo Midi7, Michele Senni8, Renato Urso6, Donata Lucci6, Aldo P Maggioni9, Luigi Tavazzi10. 1. Department of Clinical Cardiology and Heart Failure, Policlinico di Monza, Monza. 2. Cardiologia 2 Heart Failure and Heart Transplant Program, "A. De Gasperis" Cardiovascular Department, Niguarda Hospital, Milano. 3. Cardiology, University and Spedali Civili of Brescia, Brescia. 4. Cardiology Department, Orlandi Hospital, Bussolengo. 5. Cardiovascular Unit, Azienda Servizi Sanitari n. 1 Triestina, Trieste. 6. Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze. 7. Cardiology Department, Ospedali Riuniti Albano-Genzano, Albano Laziale. 8. USC Cardiovascular Medicine, Papa Giovanni XXIII Hospital, Bergamo. 9. Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze. Electronic address: centrostudi@anmco.it. 10. Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
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.
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: T Hübner; T Nickel; G Steinbeck; S Massberg; R Schramm; B Reichart; C Hagl; A Kiwi; Michael Weis Journal: Clin Res Cardiol Date: 2015-04-05 Impact factor: 5.460
Authors: Clara Gomes; Caíque Bueno Terhoch; Silvia Moreira Ayub-Ferreira; Germano Emilio Conceição-Souza; Vera Maria Cury Salemi; Paulo Roberto Chizzola; Mucio Tavares Oliveira; Silvia Helena Gelas Lage; Fernando Frioes; Edimar Alcides Bocchi; Victor Sarli Issa Journal: Open Heart Date: 2018-12-06