Why the study?
In patients with HFrEF, hypotension frequently limits the initiation and up-titration of guideline-directed medical therapy.
Does oral midodrine allow for the discontinuation of intravenous vasopressors in patients with heart failure and refractory hypotension?
Does oral midodrine allow for the discontinuation of intravenous vasopressors in patients with heart failure and refractory hypotension?
Off-label use of oral midodrine may facilitate weaning from intravenous vasopressors and enable optimization of guideline-directed medical therapy in patients with heart failure and refractory hypotension.
May facilitate GDMT up-titration in hypotensive HFrEF; leaves open need for randomized confirmation.
Hypotension in patients with heart failure is much more frequent in daily clinical practice than the 10-15% reported in clinical trials. In patients with heart failure with reduced ejection fraction (HFrEF), hypotension frequently limits the initiation and up-titration of guideline-directed medical therapy (GDMT). Midodrine is a peripheral alpha-1 agonist and a vasopressor anti-hypotensive agent approved for the treatment of orthostatic hypotension. We describe two cases where midodrine was prescribed in patients with HFrEF and hypotension. LEARNING POINTS: Hypotension in patients with systolic heart failure is a frequent presentation and can limit the initiation and optimization of guideline-directed medical therapy.Midodrine is a peripheral alpha-1 agonist and anti-hypotensive agent approved for the treatment of orthostatic hypotension.Midodrine may be used off-label in patients with heart failure with reduced ejection fraction (HFrEF) and symptomatic hypotension to allow optimization of medical therapy.
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Hajjiah et al. (2022) studied this question.
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