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Heart failure and cardiomyopathies
Original research article
Prognosis and risk stratification in patients with decompensated heart failure receiving inotropic therapy
  1. Clara Gomes1,
  2. Caíque Bueno Terhoch2,
  3. Silvia Moreira Ayub-Ferreira2,
  4. Germano Emilio Conceição-Souza2,
  5. Vera Maria Cury Salemi2,
  6. Paulo Roberto Chizzola2,
  7. Mucio Tavares Oliveira Jr2,
  8. Silvia Helena Gelas Lage2,
  9. Fernando Frioes1,
  10. Edimar Alcides Bocchi2 and
  11. Victor Sarli Issa1,2
  1. 1 Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
  2. 2 Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Victor Sarli Issa; victor.issa{at}incor.usp.br

Abstract

Objectives The prognostic significance of transient use of inotropes has been sufficiently studied in recent heart failure (HF) populations. We hypothesised that risk stratification in these patients could contribute to patient selection for advanced therapies.

Methods We analysed a prospective cohort of adult patients admitted with decompensated HF and ejection fraction (left ventricular ejection fraction (LVEF)) less than 50%. We explored the outcomes of patients requiring inotropic therapy during hospital admission and after discharge.

Results The study included 737 patients, (64.0% male), with a median age of 58 years (IQR 48–66 years). Main aetiologies were dilated cardiomyopathy in 273 (37.0%) patients, ischaemic heart disease in 195 (26.5%) patients and Chagas disease in 163 (22.1%) patients. Median LVEF was 26 % (IQR 22%–35%). Inotropes were used in 518 (70.3%) patients. In 431 (83.2%) patients, a single inotrope was administered. Inotropic therapy was associated with higher risk of in-hospital death/urgent heart transplant (OR=10.628, 95% CI 5.055 to 22.344, p<0.001). At 180-day follow-up, of the 431 patients discharged home, 39 (9.0%) died, 21 (4.9%) underwent transplantation and 183 (42.4%) were readmitted. Inotropes were not associated with outcome (death, transplant and rehospitalisation) after discharge.

Conclusions Inotropic drugs are still widely used in patients with advanced decompensated HF and are associated with a worse in-hospital prognosis. In contrast with previous results, intermittent use of inotropes during hospitalisation did not determine a worse prognosis at 180-day follow-up. These data may add to prognostic evaluation in patients with advanced HF in centres where mechanical circulatory support is not broadly available.

  • heart failure
  • decompensated heart failure
  • inotropes
  • prognosis
  • risk

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2018-000923

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    Footnotes

    • Contributors CG contributed to conception and design of the research, acquisition of data, analysis and interpretation of data, statistical analysis, drafting the manuscript and critical revision of the manuscript for important intellectual content. CBT contributed to acquisition of data, statistical analysis and critical revision of the manuscript for important intellectual content. SMA-F contributed to conception and design of the research and critical revision of the manuscript for important intellectual content. GEC-S, VMCS, PRC, MTOJ, SHGL and EAB contributed to conception and design of the research and critical revision of the manuscript for important intellectual content. FF contributed to analysis and interpretation of data, statistical analysis drafting the manuscritp and critical revision of the manuscript for important intellectual content. VSI contributed to conception and design of the research, acquisition of data and critical revision of the manuscript for important intellectual content, analysis and interpretation of data, statistical analysis and drafting the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Institutional Ethics Committee for Research Project Analysis of Heart Institute (InCor) of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.