Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

Finn Gustafsson¹, Kevin Damman², Sanem Nalbantgil³, Linda W Van Laake⁴, Laurens F Tops⁵, Thomas Thum⁶, Stamatis Adamopoulos⁷, Michael Bonios⁷, Andrew Js Coats⁸, Maria G Crespo-Leiro⁹, Mandeep R Mehra¹⁰, Gerasimos Filippatos¹¹, Loreena Hill¹², Marco Metra¹³, Ewa Jankowska¹⁴, Nicolaas de Jonge⁴, David Kaye¹⁵, Marco Masetti¹⁶, John Parissis¹⁷, Davor Milicic¹⁸, Petar Seferovic¹⁹, Giuseppe Rosano²⁰, Tuvia Ben Gal²¹

Affiliations

¹ Department of Cardiology, Rigshospitalet, University of Copenhagen, København, Denmark.
² University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
³ Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey.
⁴ Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Institute of Molecular and Therapeutic Strategies (IMTTS), Hannover Medical School, and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
⁷ Onassis Cardiac Surgery Center, Athens, Greece.
⁸ University of Warwick, Coventry, UK.
⁹ Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
¹⁰ Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
¹² School of Nursing & Midwifery, Queen's University, Belfast, UK.
¹³ Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy.
¹⁴ Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland.
¹⁵ The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
¹⁶ Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
¹⁷ Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
¹⁸ Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁹ Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia.
²⁰ St George's University Medical School of London, London, UK.
²¹ Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 36847113
DOI: 10.1002/ejhf.2814

Free article

Review

Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

Finn Gustafsson et al. Eur J Heart Fail. 2023 Apr.

Free article

. 2023 Apr;25(4):457-468.

doi: 10.1002/ejhf.2814. Epub 2023 Mar 10.

Authors

Affiliations

¹ Department of Cardiology, Rigshospitalet, University of Copenhagen, København, Denmark.
² University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
³ Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey.
⁴ Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Institute of Molecular and Therapeutic Strategies (IMTTS), Hannover Medical School, and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
⁷ Onassis Cardiac Surgery Center, Athens, Greece.
⁸ University of Warwick, Coventry, UK.
⁹ Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
¹⁰ Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
¹² School of Nursing & Midwifery, Queen's University, Belfast, UK.
¹³ Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy.
¹⁴ Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland.
¹⁵ The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
¹⁶ Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
¹⁷ Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
¹⁸ Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁹ Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia.
²⁰ St George's University Medical School of London, London, UK.
²¹ Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 36847113
DOI: 10.1002/ejhf.2814

Abstract

This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support).

Keywords: Advanced heart failure; Cardiorenal syndrome; Inotrope; Mechanical circulatory support; Palliation.

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References

1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24:4-131.
1. DesJardin JT, Teerlink JR. Inotropic therapies in heart failure and cardiogenic shock: an educational review. Eur Heart J Acute Cardiovasc Care. 2021;10:676-86.
1. Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:1505-35.
1. Stewart GC, Ambardekar AV, Kittleson MM. Defining ambulatory advanced heart failure: MedaMACS and beyond. Curr Heart Fail Rep. 2017;14:498-506.
1. Chioncel O, Parissis J, Mebazaa A, Thiele H, Desch S, Bauersachs J, et al. Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22:1315-41.

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Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

Affiliations

Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology

Authors

Affiliations

Abstract

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Medical