February 27, 2023Open Access
View Full PaperInotropic Therapy in Patients with Advanced Heart Failure. A Clinical Consensus Statement from the Heart Failure Association of the European Society of Cardiology
Structured PICO
P
Population
Patients with advanced heart failure, including those with persistent congestion, systemic hypoperfusion, need for palliation, or awaiting left ventricular assist devices or heart transplantation
I
Intervention
Inotropic therapy (traditional and novel drugs), including home inotropic therapy
This consensus statement provides guidance on the use of inotropic therapy in advanced heart failure, expanding considerations beyond acute decompensation to include palliation, home therapy, and bridge to advanced therapies.
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).