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Effects of Widespread Inotrope Use in Acute Heart Failure Patients

 Jeehoon Kang  ;  Hyun-Jai Cho  ;  Hae-Young Lee  ;  Sangjun Lee  ;  Sue K. Park  ;  Sang Eun Lee  ;  Jae-Joong Kim  ;  Eun-Seok Jeon  ;  Shung Chull Chae  ;  Sang Hong Baek  ;  Seok-Min Kang  ;  Dong-Ju Choi  ;  Byung-Su Yoo  ;  Kye Hun Kim  ;  Myeong-Chan Cho  ;  Byung-Hee Oh 
 JOURNAL OF CLINICAL MEDICINE, Vol.7(10) : E368, 2018 
Journal Title
Issue Date
acute heart failure ; blood pressure ; initial systolic ; inotrope
Current guidelines recommend that inotropes should not be used in patients with normal systolic blood pressure (SBP). However, this is not supported with concrete evidence. We aimed to evaluate the effect of inotropes in acute heart failure (HF) patients from a nationwide HF registry. A total of 5625 patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. The primary outcomes were in-hospital adverse events and 1-month mortality. Among the total population, 1703 (31.1%) received inotropes during admission. Inotrope users had a higher event rate than non-users (in-hospital adverse events: 13.3% vs. 1.4%, p < 0.001; 1-month mortality: 5.5% vs. 2.5%, p < 0.001), while inotrope use was an independent predictor for clinical outcomes (in-hospital adverse events: ORadjusted 5.459, 95% CI 3.622⁻8.227, p < 0.001; 1-month mortality: HRadjusted 1.839, 95% CI 1.227⁻2.757, p = 0.003). Subgroup analysis showed that inotrope use was an independent predictor for detrimental outcomes only in patients with normal initial SBP (≥90 mmHg) (in-hospital adverse events: ORadjusted 5.931, 95% CI 3.864⁻9.104, p < 0.001; 1-month mortality: HRadjusted 3.584, 95% CI 1.280⁻10.037, p = 0.015), and a propensity score-matched population showed consistent results. Clinicians should be cautious with the usage of inotropes in acute heart failure patients, especially in those with a normal SBP.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
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