Author + information
- Tiana Jespersen Nizamic, MD,
- Larry A. Allen, MD, MHS and
- Shannon M. Dunlay, MD, MS∗ ()
- ↵∗Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
As underscored throughout our paper, we strongly agree that published studies have failed to provide adequate information comparing the risks and benefits of intravenous inotropes used in a range of ambulatory patients with advanced heart failure (1). The goal of our review was to summarize the available evidence and highlight gaps in knowledge where they exist. A total of 66 studies (13 randomized controlled trials and 53 observational studies) met our inclusion and exclusion criteria and were included in the systematic review. As we set out to summarize all potentially applicable evidence, we included studies published prior to the widespread use of implantable cardioverter-defibrillators and did not limit the review to studies of patients with a specific cardiac index. Instead, we reviewed and analyzed the limitations of the available data and brought attention to the need for future studies. The art of medicine will always be practiced by the careful integration of imperfect trials, systematic observations, clinical gestalt, and patient preference. We hope that our systematic review and this discussion will prompt the performance of well-designed studies to better evaluate the impact of ambulatory intravenous inotropes, as used in contemporary practice, on clinical outcomes.
Please note: Dr. Dunlay is supported by U.S. National Institutes of Health grant K23 HL 116643. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation