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Inotropes do not increase mortality in advanced heart failure

机译:正性肌力药不会增加晚期心力衰竭的死亡率

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摘要

Inotrope use is one of the most controversial topics in the management of heart failure. While the heart failure community utilizes them and recognizes the state of inotrope dependency, retrospective analyses and registry data have overwhelmingly suggested high mortality, which is logically to be expected given the advanced disease states of those requiring their use. Currently, there is a relative paucity of randomized control trials due to the ethical dilemma of creating control groups by withholding inotropes from patients who require them. Nonetheless, results of such trials have been mixed. Many were also performed with agents no longer in use, on patients without an indication for inotropes, or at a time before automatic cardio-defibrillators were recommended for primary prevention. Thus, their results may not be generalizable to current clinical practice. In this review, we discuss current indications for inotrope use, specifically dobutamine and milrinone, depicting their mechanisms of action, delineating their patterns of use in clinical practice, defining the state of inotrope dependency, and ultimately examining the literature to ascertain whether evidence is sufficient to support the current view that these agents increase mortality in patients with heart failure. Our conclusion is that the evidence is insufficient to link inotropes and increased mortality in low output heart failure.
机译:在心力衰竭的治疗中,使用Introtrope是最有争议的主题之一。当心力衰竭社区利用它们并认识到inotrope依赖的状态时,回顾性分析和注册表数据已绝大多数显示出高死亡率,考虑到需要使用它们的人的晚期疾病状态,这在逻辑上是可以预期的。目前,由于在伦理上面临两难选择,即通过从需要治疗的患者中禁用正性肌力药物来创建对照组,这在伦理上是比较困难的,因此随机对照试验相对较少。尽管如此,这种试验的结果好坏参半。在不再使用正性肌力药的患者中,或在推荐使用自动心脏除纤颤器作为一级预防措施之前,也对许多患者使用了不再使用的药物。因此,其结果可能无法推广到当前的临床实践。在这篇综述中,我们讨论了使用Inotrope的当前适应症,特别是多巴酚丁胺和米力农,描述了它们的作用机理,描述了其在临床实践中的使用模式,定义了Inotrope的依赖状态,并最终检查了文献以确认证据是否足够支持目前的观点,即这些药物会增加心力衰竭患者的死亡率。我们的结论是,证据不足以将正性肌力药和低输出心力衰竭的死亡率增加联系起来。

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