Inotropic therapy in patients with advanced heart failure

Abstract

Objective: Analyze inotropic therapy, the main insecurities and the clinical scenario for implementation in patients with Advanced Heart Failure (HF). Bibliographic Review: Inotropes were introduced in the treatment of HF because they improve the performance of myocardial contractility. Many of these medications are used in decompensated conditions, as bridge therapy, before carrying out advanced or palliative procedures. However, there is still no consensus at what stage of the disease inotropes should be considered, nor which agent or the next course of action. There are reports that they increased the death rate due to adverse effects. But due to the improvement in the signs and symptoms of the advanced disease, they are still often used. The most commonly used drugs are dobutamine and milrinone, although levosimendan is gaining more and more use. Furthermore, there is Omecamtiv Mecarbil, a promising drug due to its few adverse effects. Although there are no clear guidelines on when to implement therapy, they are generally used in more serious cases. Final considerations: The difficulty of identifying which patients will benefit from inotropic therapy can affect mortality results, which is why more studies are needed to support the specialist's decision.