Inotropic therapy in patients with congestive heart failure

Patients suffering advanced heart failure symptoms as a consequence of left ventricular systolic dysfunction have limited treatment options. Inotropic support is frequently used in an effort to ameliorate symptoms and improve functional status. The authors reviewed the published literature for evidence to guide the use of inotropes in both the acute and chronic phases of advanced heart failure. The vast majority of studies conclude that long-term oral and intravenous inotropes increase mortality. The effects of long-term inotropes on quality of life measures and hemodynamics are highly variable. Short-term use of intravenous inotropes for acute exacerbations of chronic heart failure may provide clinical and hemodynamic improvement without increased mortality. Intravenous inotropes may safely improve clinical and hemodynamic outcomes in acute heart failure exacerbations. Invasive hemodynamic monitoring should be considered to help in patient selection and dose determination for long-term inotropic support as a pharmacologic bridge to definitive therapy, or as palliative therapy with the understanding that this approach is associated with an increased mortality.