Ambulatory Inotrope Infusions in Advanced Heart Failure
| Autor: | Larry A. Allen, Colleen K. McIlvennan, Shannon M. Dunlay, M. Hassan Murad, Tiana Nizamic, Daniel D. Matlock, Sara E. Wordingham |
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| Rok vydání: | 2018 |
| Předmět: |
Inotrope
medicine.medical_specialty Palliative care business.industry 030204 cardiovascular system & hematology medicine.disease law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Relative risk Heart failure Meta-analysis Emergency medicine Ambulatory Medicine Observational study 030212 general & internal medicine Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: Heart Failure. 6:757-767 |
| ISSN: | 2213-1779 |
| DOI: | 10.1016/j.jchf.2018.03.019 |
| Popis: | Objectives This study sought to systematically review the available evidence of risks and benefits of ambulatory intravenous inotrope therapy in advanced heart failure (HF). Background Ambulatory inotrope infusions are sometimes offered to patients with advanced Stage D HF; however, an understanding of the relative risks and benefits is lacking. Methods On August 7, 2016, we searched SCOPUS, Web of Science, Ovid EMBASE, and Ovid MEDLINE for studies of long-term use of intravenous inotropes in outpatients with advanced HF. Meta-analysis was performed using random effects models. Results A total of 66 studies (13 randomized controlled trials and 53 observational studies) met inclusion criteria. Most studies were small and at high risk for bias. Pooled rates of death (41 studies), all-cause hospitalization (15 studies), central line infection (13 studies), and implantable cardioverter-defibrillator shocks (3 studies) of inotropes were 4.2, 22.2, 3.6, and 2.4 per 100 person-months follow-up, respectively. Improvement in New York Heart Association (NYHA) functional class was greater in patients taking inotropes than in controls (mean difference of 0.60 NYHA functional classes; 95% confidence interval [CI]: 0.22 to 0.98; p = 0.001; 5 trials). There was no significant difference in mortality risk in those taking inotropes compared with controls (pooled risk ratio: 0.68; 95% CI: 0.40 to 1.17; p = 0.16; 9 trials). Data were too limited to pool for other outcomes or to stratify by indication (i.e., bridge-to-transplant or palliative). Conclusions High-quality evidence for the risks and benefits of ambulatory inotrope infusions in advanced HF is limited, particularly when used for palliation. Available data suggest that inotrope therapy improves NYHA functional class and does not impact survival. |
| Databáze: | OpenAIRE |
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