SummaryThe heart failure guideline in Japan has stated the necessity of investigating the role of oral inotropic agents in patients with chronic heart failure (CHF), which are clinically available only in Japan. A total of 1,846 consecutive patients with heart failure (mean: 69.5 years old, 1,279 males) treated at our institute from November 2009 to August 2010 were investigated retrospectively. Thirty-one patients (1.84%) who had taken oral inotropic agents (pimobendan 27, docarpamine 6, and denopamine 4) were extracted for this study, and the efficacy and limitations of the treatments were analyzed. Following the oral inotropic treatment, the NYHA functional class (P = 0.017), cardiothoracic ratio (P = 0.002) and B-type natriuretic peptide levels (P = 0.011) were significantly improved, and the number of emergency room (ER) visits (P < 0.001) and hospitalizations (P < 0.001) were significantly reduced. The nonsurviving patients (n = 7/31, 22.6%) were significantly older (P = 0.02) and tended to have a larger cardiothoracic ratio (P = 0.084) compared with the survivors. An absence of concomitant beta-blocker therapy was significantly associated with a worse prognosis (oneyear mortality 2/21 versus 5/10, log rank, P = 0.011). Oral inotropic agents brought about improvements in the clinical parameters of CHF and a reduction in ER visits and hospitalizations. However, concomitant beta-blocker therapy should be considered for patients receiving oral inotropic treatment. (Int Heart J 2013; 54: 75-81) Key words: Pimobendan, Denopamine, Docarpamine, Beta-blocker A lthough several oral inotropic agents have been developed for the treatment of advanced heart failure, such as oral catecholamines, phosphodiesterase III (PDE III) inhibitors, and Ca-sensitizers, [1][2][3][4][5] there have been no reports showing improvement in the patient survival for these treatments. On the other hand, beta-blocker therapy, [6][7][8] which is pharmacologically active in an opposite site to the inotropic agents, has brought about not only improvement in the longterm outcomes, but also improvement in cardiac function in patients with chronic heart failure (CHF). However, many patients with advanced heart failure have difficulty being weaned from intravenous inotropic therapy or recovering from their low output condition. There are few countries where oral inotropic agents are available for such instances. In Japan, a few oral inotropic agents, including pimobendan, denopamine, and docarpamine, are clinically available for inotropic treatment in patients with advanced heart failure 1,5) or as supportive treatment for beta-blocker therapy.9) The guidelines for the treatment of chronic heart failure from the Japanese Circulation Society have pointed out the necessity for clinical investigations concerning the efficacy and limitation of the oral inotropic treatments, which are available only in Japan, and are not approved in Western countries. Thus, the present study analyzed the real-world use, efficacy, and limitations of oral inotropic ag...