Outpatient Continuous Intravenous Inotropy in the Modern Era.

Autor:	Fishkin T; From the Department of Medicine, Westchester Medical Center., Spira Y; From the Department of Medicine, Westchester Medical Center., D'Ascanio A; New York Medical College, Valhalla, NY., Bahl S; Department of Cardiology, Westchester Medical Center., Frishman WH; Department of Cardiology, Westchester Medical Center., Gupta CA; Department of Cardiology, Westchester Medical Center., Aronow WS; Department of Cardiology, Westchester Medical Center., Levine A; Department of Cardiology, Westchester Medical Center., Gass A; Department of Cardiology, Westchester Medical Center., Pan S; Department of Cardiology, Westchester Medical Center., Lanier GM; Department of Cardiology, Westchester Medical Center.
Jazyk:	angličtina
Zdroj:	Cardiology in review [Cardiol Rev] 2024 Jul 06. Date of Electronic Publication: 2024 Jul 06.
DOI:	10.1097/CRD.0000000000000750
Abstrakt:	The use of continuous inotropy in patients with advanced heart failure (HF) has been historically controversial due to the prevailing notion that it will increase mortality. In practice, clinicians have continued to revisit this idea as there remains a lack of treatment options for patients in stage D HF. Clinical trials in the past have generally not shown favorable effects of long-term chronic infusions of positive IV inotropic agents on symptoms and exercise tolerance. However, these older studies which indicated poor outcomes with palliative inotropes may not apply to current practice. Modern trials and case series have shown that milrinone and dobutamine may be safely used in patients who are bridging to device therapy or transplant or for palliation. Broad adoption of mortality-reducing modern guideline-directed medical therapy and implantable cardioverter defibrillators may have contributed to the positive results that contemporary trials have seen with inotrope use. For the stage D HF patient, modern use of outpatient inotropy (OI) can alleviate symptom burden and prolong time spent at home. Additionally, more recent studies and case series suggest that OI can be a reasonable alternative to left ventricular assist device placement for both bridging to transplant or as destination therapy. In the appropriate patient, and according to the patient's informed decision and preference, this may be a viable alternative therapeutic option. Contemporary data suggest that OI should be considered in patients who are being evaluated for advanced therapies. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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