Abstract

Objectives

Current guidelines restrict the use of inotropes for the treatment for heart failure (HF) unless the patients are hypotensive or hypoperfused because of safety concerns. This study sought to characterise the contemporary real-world use of inotropes and associated long-term outcomes according to systolic blood pressure (sBP) and perfusion status.

Design

A multicentre prospective cohort study.

Setting

This study was nested from the Kyoto Congestive Heart Failure registry, which included consecutive Japanese patients admitted for HF.

Participants

We categorised 3995 patients into two groups: sBP ≥90 mm Hg and warm profile group, and sBP <90 mm Hg or cold profile group. In each group, patients were stratified across the use of inotropes within 24 hours of hospital presentation.

Primary and secondary outcomes

The primary outcome was all-cause death throughout follow-up. Secondary outcomes included cardiovascular death throughout follow-up, all-cause death during index hospitalisation and after discharge, and HF hospitalisation.

Results

A total of 793 patients (20%) presented with sBP <90 mm Hg or cold profile, whereas 3202 patients had sBP ≥90 mm Hg and warm profile; 276 patients (35%) in the sBP <90 mm Hg/cold group and 312 patients (10%) in the sBP ≥90 mm Hg/warm group received initial inotropic treatment. Adjusted excess risk of inotrope use relative to no inotrope for the primary outcome measure was significant in the sBP ≥90 mm Hg/warm group (adjusted HR), 1.36; 95% CI 1.09 to 1.72, p=0.006) but not in the sBP <90 mm Hg/cold group (adjusted HR, 1.28, 95% CI 0.96 to 1.69, p=0.09). Risk for postdischarge all-cause death and HF hospitalisation was not significantly different between the patients with inotropes and no inotropes in both groups.

Conclusion

Inotrope use in the absence of hypotension and hypoperfusion is still common, but associated with a worse long-term prognosis.

Trial registration number

UMIN000015238.

Details

Title
Current use of inotropes according to initial blood pressure and peripheral perfusion in the treatment of congestive heart failure: findings from a multicentre observational study
Author
Nagao, Kazuya 1   VIAFID ORCID Logo  ; Kato, Takao 2   VIAFID ORCID Logo  ; Yaku, Hidenori 3 ; Morimoto, Takeshi 4   VIAFID ORCID Logo  ; Inuzuka, Yasutaka 5 ; Tamaki, Yodo 6 ; Yamamoto, Erika 2 ; Yoshikawa, Yusuke 2 ; Kitai, Takeshi 7 ; Taniguchi, Ryoji 8 ; Iguchi, Moritake 9   VIAFID ORCID Logo  ; Kato, Masashi 3 ; Takahashi, Mamoru 10 ; Jinnai, Toshikazu 11 ; Ikeda, Tomoyuki 12 ; Kawai, Takafumi 13 ; Komasa, Akihiro 14 ; Nishikawa, Ryusuke 15 ; Kawase, Yuichi 16 ; Morinaga, Takashi 17 ; Su, Kanae 18 ; Kawato, Mitsunori 19 ; Seko, Yuta 2 ; Inada, Tsukasa 1 ; Inoko, Moriaki 20 ; Toyofuku, Mamoru 18 ; Furukawa, Yutaka 21 ; Nakagawa, Yoshihisa 22 ; Ando, Kenji 17 ; Kadota, Kazushige 16 ; Shizuta, Satoshi 2   VIAFID ORCID Logo  ; Ono, Koh 2 ; Sato, Yukihito 8 ; Kuwahara, Koichiro 23 ; Ozasa, Neiko 2 ; Kimura, Takeshi 2   VIAFID ORCID Logo 

1  Department of Cadiology, Osaka Red Cross Hospital, Osaka, Japan 
2  Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan 
3  Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan 
4  Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan 
5  Department of Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan 
6  Department of Cardiology, Tenri Hospital, Tenri, Japan 
7  Division of Heart Failure, National Cerebral and Cardiovascular Center, Suita, Japan 
8  Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan 
9  Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan 
10  Department of Cardiology, Shimabara Hospital, Kyoto, Japan 
11  Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan 
12  Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan 
13  Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan 
14  Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan 
15  Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan 
16  Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan 
17  Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan 
18  Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan 
19  Department of Cardiology, Nishi Kobe Medical Center, Kobe, Japan 
20  Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan 
21  Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan 
22  Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan 
23  Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan 
First page
e053254
Section
Cardiovascular medicine
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
e-ISSN
20446055
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1136/bmjopen-2021-053254
ProQuest document ID
2621457875
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.