Comparing Outcomes Of Patients With End-stage Heart Failure And History Of Ventricular Tachyarrhythmias On And Off Continuous Inotropes

• Published in: Journal of cardiac failure Vol. 29; no. 4; p. 658
• Main Authors: Sejpal, Manasi, Very, Bradley, Khan, Shazli, Yunis, Adil, Boyle, Brenden, Thoma, Floyd, Sezer, Ahmet, Hickey, Gavin
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.272

Heart Failure (HF) and inotropic agents used in end-stage disease are both independently associated with an increased risk of ventricular tachyarrhythmias including ventricular tachycardia (VT) and ventricular fibrillation (VF). The extent to which inotropic agents impact mortality in patients with end-stage HF and a history of VT/VF remains unknown. This study aims to compare mortality in patients with end-stage HF and history of VT/VF initiated on inotropes during hospitalization and discharged on versus off inotropes. We expect an increased mortality in patients with end-stage HF with a history of VT/VF discharged on inotropes. This is a retrospective observational study that includes adult patients with AHA/ACC Stage D HF and a documented history of VT/VF admitted to University of Pittsburgh Medical Center (UPMC) hospitals between 1/2010 and 06/2018 and initiated on inotropes. Patients with prior inotrope exposure, ejection fraction > 35%, isolated right ventricular dysfunction, congenital heart disease, intraoperative or less than 24 hours of inotrope therapy, prior mechanical circulatory support, history of heart transplant, and those without follow-up data were excluded from the analysis. Patients discharged on and off continuous inotropes were followed for 2 years or until the study endpoints. Primary endpoints included heart transplant, death, or readmission for inotrope therapy in those patients discharged off inotropes. We performed Kaplan Meier (KM) survival probability analysis to determine mortality difference between groups. We identified 76 patients with end-stage HF who had a history of VT/VF who were initiated on inotropes during hospitalization. Of these, 30 patients were discharged on inotropes and 46 were discharged off inotropes. The patients were predominantly male (71.7%), Caucasian (78.2%) with a median age of 66 years (±7). Age, demographics, comorbidities, and medications were similar between the two groups. The KM survival curves for each group from discharge until the occurrence of study endpoints were presented in Figure 1. There was a higher proportion of patients that died on inotropes 26.7% (8 of 30) versus off 19.5% (9 of 46), however there was no statistically significant difference in survival times between the two groups (log rank test P=0.1728). In patients with AHA/ACC stage D heart failure and a known history of VT/VF, there is a higher proportion of patients who died on inotropes compared to off, however P value > 0.05. More data will be collected to improve statistical power.