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J Heart Lung Transplant. 2014 Oct;33(10):1056-65. doi: 10.1016/j.healun.2014.05.015. Epub 2014 Jun 4.

Treatment with inotropes and related prognosis in acute heart failure: Contemporary data from the Italian Network on Heart Failure (IN-HF) Outcome registry.

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  • 1Department of Clinical Cardiology and Heart Failure, Policlinico di Monza, Monza.
  • 2Cardiologia 2 Heart Failure and Heart Transplant Program, "A. De Gasperis" Cardiovascular Department, Niguarda Hospital, Milano.
  • 3Cardiology, University and Spedali Civili of Brescia, Brescia.
  • 4Cardiology Department, Orlandi Hospital, Bussolengo.
  • 5Cardiovascular Unit, Azienda Servizi Sanitari n. 1 Triestina, Trieste.
  • 6Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze.
  • 7Cardiology Department, Ospedali Riuniti Albano-Genzano, Albano Laziale.
  • 8USC Cardiovascular Medicine, Papa Giovanni XXIII Hospital, Bergamo.
  • 9Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Firenze. Electronic address: centrostudi@anmco.it.
  • 10Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.



In the recent Italian Network on Heart Failure (IN-HF) Outcome registry, including 1,855 patients with acute heart failure (AHF), we reviewed the use of inotropes and their prognostic implication on in-hospital and 12-month mortality.


IN-HF Outcome is a prospective, multicenter, observational, study involving 61 Italian cardiology centers. AHF patients have been enrolled over a 2-year period and followed-up for 1 year. Inotropes were used in 360 patients (19.4%).


Patients who received inotropes had a more severe clinical and hemodynamic profile than those who did not and exhibited a significantly higher rate of in-hospital (21.4% vs 2.7%, p < 0.01) and 1-year (50.6% vs 17.7%, p < 0.01) mortality. At entry, systolic blood pressure (SBP) was ≤ 110 mm Hg in 58%, 111 to 130 mm Hg in 24.5%, and > 130 mm Hg in 17.5%. Multivariable analyses showed use of inotropes was the strongest predictor of all-cause death. These data were confirmed by propensity score analyses. According to SBP at entry, the 2 groups with SBP > 110 mm Hg who took inotropes, despite a more favorable clinical profile, exhibited a similar worse prognosis, particularly at 1 year: 56.3% (≤ 110 mm Hg), 43.7% (111-130 mm Hg), and 40.3% (>130 mm Hg) vs 17.7%.


Inotropes were used in nearly 20% of the patient admitted for AHF, and this treatment was associated with a short-term to medium-term poor prognosis. An inappropriate use of inotropes in patients with normal to high SBP, and presumably preserved cardiac output, may have significantly contributed to affect the all-group outcome.

Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.


IN-HF Outcome registry; acute heart failure; death; inotropes; prognosis; systolic blood pressure

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