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Titolo:
Inotropic therapy for heart failure: An evidence-based approach
Autore:
Felker, GM; OConnor, CM;
Indirizzi:
Duke Univ, Med Ctr, Dept Med, Div Cardiol, Durham, NC 27710 USA Duke UnivDurham NC USA 27710 Dept Med, Div Cardiol, Durham, NC 27710 USA
Titolo Testata:
AMERICAN HEART JOURNAL
fascicolo: 3, volume: 142, anno: 2001,
pagine: 393 - 401
SICI:
0002-8703(200109)142:3<393:ITFHFA>2.0.ZU;2-3
Fonte:
ISI
Lingua:
ENG
Soggetto:
HIBERNATING MYOCARDIUM; ADRENERGIC-STIMULATION; PLASMA NOREPINEPHRINE; INTRAVENOUS MILRINONE; MULTICENTER TRIAL; ORAL MILRINONE; DOBUTAMINE; MORTALITY; BENEFIT; CARDIOMYOPATHY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
55
Recensione:
Indirizzi per estratti:
Indirizzo: Felker, GM Duke Univ, Med Ctr, Duke N Hosp, Box 31185,Erwin Rd, Durham, NC27710 USA Duke Univ Box 31185,Erwin Rd Durham NC USA 27710 , NC 27710 USA
Citazione:
G.M. Felker e C.M. O'Connor, "Inotropic therapy for heart failure: An evidence-based approach", AM HEART J, 142(3), 2001, pp. 393-401

Abstract

Background Agents that increase cardiac contractility (positive inotropes)have beneficial hemodynamic effects in patients with acute and chronic heart failure but have frequently led to increased mortality when given on a long-term basis. Despite this fact, inotropes remain commonly used in the management of heart failure. Methods We reviewed the available data on short- and long-term inotrope use in heart failure, emphasizing high-quality evidence on the basis of randomized trials that were powered to address clinical end points. Results Available data suggest that long-term inotropic therapy has a negative impact on survival in patients with heart failure, regardless of the agent used. The data that inotropic therapy improves quality of life are mixed. High-quality randomized evidence is locking for the use of inotropes for other heart failure indications, such as for acute decompensations or as a "bridge to transplant. "Conclusions On the basis of the available evidence, the routine use of inotropes as heart failure therapy is not indicated in either the acute or chronic setting. Potentially appropriate uses of inotropes include as temporary treatment of diuretic-refractory acute heart failure decompensations or as a bridge to definitive treatment such as revascularization or cardiac transplantation. Inotropes also may be appropriate as a palliative measure in patients with truly end-stage heart failure. A model of heart failure pathophysiologic features that combines an understanding of both hemodynamic andneurohormonal factors will be required to best develop and evaluate novel treatments for advanced heart failure.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/07/20 alle ore 15:03:58