Long‐term administration of intravenous inotropes in advanced heart failure

Abstract

Background Patients in heart transplantation (HTx) waiting list for advanced heart failure (HF) are susceptible to acute deterioration refractory to standard HF medical therapies. Limited data are available on long-term in-hospital continuous intravenous (IV) inotropic therapy as bridge to definite therapies. Methods and results Wereviewed medicalrecordsofallhearttransplantrecipientstreatedinthepre-HTx phase with in-hospital continuous IV inotropes at our institution between 2012 and 2018. We analysed data before the beginning of continuous IV therapy and at the moment of HTx. We report data of 24 patients (mean age of 43.5 ± 15.7 years) treated with IV inotropes as bridge to HTx (median follow-up of 28 months after HTx). The main length of IV inotropic therapy was 84 ± 66 days (min 22; max 264 days). At the beginning, the most frequently used inotrope was dopamine (median dosage of 3 mcg/kg/min, interquartile range 2.5-3.75), alone (n = 11, 46%) or in combination with other inotropes (n = 13, 54%). In 18 patients, the class of inotropes was changed during the hospitalization. We registered a progressive improvement of perfusion markers and neuro-hormonal activation. Conclusion In-hospital continuous parenteral inotropic therapy may serve as a temporary pharmacological bridge to HTx in patients with advanced HF that are actively listed to HTx with good reply in terms of prognosis and perfusion markers.

Continuous Renal Replacement Therapy for Hypertension Complicated by Refractory Heart Failure: An Analysis of Safety and Nursing Highlights

“…Moreover, CRRT is shown to remove inflammatory mediators released in large quantities due to HF-induced cardiomyocyte injury and necrosis, protect the functions of cardiomyocytes and vascular endothelial cells, and promote the recovery of CF [ 28 ], which may be one of the reasons for the better improvement of patients with CRRT. Compared with previous research results [ 29 , 30 ], the excellent therapeutic effect of CRRT can just make up for the limitations of insufficient clinical treatment plans and poor therapeutic effect for RHF at this stage and provide more reliable treatment services for RHF patients, guaranteeing life safety of RHF patients.…”

Advanced heart failure: from definitions to therapeutic options

“… 1 Nevertheless, selected patients can benefit from intravenous (IV) inotropes as a bridge to temporary MCS, long-term MCS, or HTx and as short-term therapy when low cardiac output and evidence of end-organ dysfunction prevail. 10 Moreover, continuous IV inotropes may be considered as a palliative measure for patients without other advanced treatment options.…”

Haemodynamic effects of sacubitril/valsartan in advanced heart failure

“…The prevalence of heart failure (HF) increases with the ageing population, and advances in medical therapy have improved HF survival overall and for the 1-10% of patients with advanced disease. 1,2 Sacubitril/valsartan is a first-in-class angiotensin-II receptor neprilysin inhibitor (ARNI) that acts on the neutral endopeptidase and renin-angiotensin-aldosterone systems and is recommended in current treatment guidelines to reduce morbidity and mortality in patients with chronic, symptomatic HF with reduced ejection fraction. 3 To date, there are limited data regarding the use of sacubitril/valsartan in patients with advanced HF who are listed for cardiac transplantation.…”