Beta-blockers and Ambulatory Inotropic Therapy

• Published in: Journal of cardiac failure 2022-08, Vol.28 (8), p.1309-1317
• Main Authors: Zaghlol, Raja, Ghazzal, Amre, Radwan, Sohab, Zaghlol, Louay, Hamad, Ahmad, Chou, Jiling, Ahmed, Sara, Hofmeyer, Mark, Rodrigo, Maria E., Kadakkal, Ajay, Lam, Phillip H., Rao, Sriram D., Weintraub, William S., Molina, Ezequiel J., Sheikh, Farooq H., Najjar, Samer S.
• Format: Article
• Language: English
• Subjects: arrhythmias; beta-blockers; inotropes; Milrinone
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.03.352

•Continuous infusion of ambulatory inotropes is an option for managing end-stage heart failure.•Beta-blockers can be used with ambulatory milrinone if tolerated.•The combination of inotropes and beta-blockers may be associated with fewer hospitalizations due to heart failure and ventricular arrhythmias. Continuous infusion of ambulatory inotropic therapy (AIT) is increasingly used in patients with end-stage heart failure (HF). There is a paucity of data concerning the concomitant use of beta-blockers (BB) in these patients. We retrospectively reviewed all patients discharged from our institution on AIT. The cohort was stratified into 2 groups based on BB use. The 2 groups were compared for differences in hospitalizations due to HF, ventricular arrhythmias and ICD therapies (shock or antitachycardia pacing). Between 2010 and 2017, 349 patients were discharged on AIT (95% on milrinone); 74% were males with a mean age of 61 ± 14 years. BB were used in 195 (56%) patients, whereas 154 (44%) did not receive these medications. Patients in the BB group had longer duration of AIT support compared to those in the non-BB group (141 [1–2114] vs 68 [1–690] days). After adjusting for differences in baseline characteristics and indication for AIT, patients in the BB group had significantly lower rates of hospitalizations due to HF (hazard ratio [HR] 0.61 (0.43–0.86); P = 0.005), ventricular arrhythmias (HR 0.34 [0.15–0.74]; P = 0.007) and ICD therapies (HR 0.24 [0.07–0.79]; P = 0.02). In patients with end-stage HF on AIT, the use of BB with inotropes was associated with fewer hospitalizations due to HF and fewer ventricular arrhythmias. [Display omitted] Visual take home graphic: heart failure hospitalizations and ventricular arrhythmias in patients on AIT. Left panel: summary of patients’ characteristics; right panel: Kaplan-Meier curves comparing A, HF hospitalization-free survival; B, ventricular arrhythmia-free survival between patients in the BB group vs patients in the non-BB group.