PMID- 30007556
OWN - NLM
STAT- MEDLINE
DCOM- 20191202
LR  - 20191202
IS  - 2213-1787 (Electronic)
IS  - 2213-1779 (Print)
IS  - 2213-1779 (Linking)
VI  - 6
IP  - 9
DP  - 2018 Sep
TI  - Ambulatory Inotrope Infusions in Advanced Heart Failure: A Systematic Review and 
      Meta-Analysis.
PG  - 757-767
LID - S2213-1779(18)30275-0 [pii]
LID - 10.1016/j.jchf.2018.03.019 [doi]
AB  - 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.
CI  - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Nizamic, Tiana
AU  - Nizamic T
AD  - Department of Medicine, University of Colorado at Denver, Denver, Colorado.
FAU - Murad, M Hassan
AU  - Murad MH
AD  - Division of Preventive, Occupational, and Aerospace Medicine, Department of 
      Medicine, Mayo Clinic, Rochester, Minnesota.
FAU - Allen, Larry A
AU  - Allen LA
AD  - Division of Cardiology, Department of Medicine, University of Colorado, Denver, 
      Colorado.
FAU - McIlvennan, Colleen K
AU  - McIlvennan CK
AD  - Division of Cardiology, Department of Medicine, University of Colorado, Denver, 
      Colorado.
FAU - Wordingham, Sara E
AU  - Wordingham SE
AD  - Section of Palliative Medicine, Department of Medicine, Mayo Clinic, Scottsdale, 
      Arizona.
FAU - Matlock, Daniel D
AU  - Matlock DD
AD  - Division of Geriatrics, Department of Medicine, University of Colorado at Denver, 
      Denver, Colorado.
FAU - Dunlay, Shannon M
AU  - Dunlay SM
AD  - Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 
      Electronic address: dunlay.shannon@mayo.edu.
LA  - eng
GR  - K23 HL116643/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, N.I.H., Extramural
PT  - Systematic Review
DEP - 20180711
PL  - United States
TA  - JACC Heart Fail
JT  - JACC. Heart failure
JID - 101598241
RN  - 0 (Cardiotonic Agents)
SB  - IM
CIN - JACC Heart Fail. 2018 Sep;6(9):768-770. PMID: 30007555
CIN - JACC Heart Fail. 2018 Dec;6(12):1050-1051. PMID: 30497647
CIN - JACC Heart Fail. 2018 Dec;6(12):1051. PMID: 30497649
MH  - Ambulatory Care
MH  - Arrhythmias, Cardiac/*epidemiology
MH  - Cardiotonic Agents/*administration & dosage
MH  - Heart Failure/*drug therapy
MH  - Heart Transplantation
MH  - Home Infusion Therapy/*methods
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Infusions, Intravenous
MH  - *Mortality
MH  - Palliative Care
MH  - Quality of Life
MH  - Walk Test
PMC - PMC6119101
MID - NIHMS958908
OTO - NOTNLM
OT  - death
OT  - hospitalization
OT  - palliative care
OT  - risk
OT  - transplant
EDAT- 2018/07/17 06:00
MHDA- 2019/12/04 06:00
PMCR- 2019/09/01
CRDT- 2018/07/16 06:00
PHST- 2017/12/01 00:00 [received]
PHST- 2018/03/28 00:00 [revised]
PHST- 2018/03/28 00:00 [accepted]
PHST- 2018/07/17 06:00 [pubmed]
PHST- 2019/12/04 06:00 [medline]
PHST- 2018/07/16 06:00 [entrez]
PHST- 2019/09/01 00:00 [pmc-release]
AID - S2213-1779(18)30275-0 [pii]
AID - 10.1016/j.jchf.2018.03.019 [doi]
PST - ppublish
SO  - JACC Heart Fail. 2018 Sep;6(9):757-767. doi: 10.1016/j.jchf.2018.03.019. Epub 
      2018 Jul 11.