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Urgent need for investigation of inotropic agents in HF patients
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In a recent study, researchers found marked differences in the use of inotropic agents for patients with heart failure at a diverse group of US hospitals.
“Guidelines state that inotropes should be confined to carefully selected patients with low BP and reduced cardiac output who can have BP and heart rhythm monitored closely. Registries suggest that this group represents approximately 3% of all patients hospitalized with HF. Our study and others suggest that many more (7% to 12%) patients are being treated with these agents,” researchers wrote.
The study included data from 189,948 hospitalizations for HF at 376 hospitals from 2009 to 2010. During the 2 years, per hospital, the median volume of patients with HF was 394. Hierarchical generalized linear models (HGLM) were used to assess the risk-standardized use of inotrope agents; hierarchical logistic regression was used to estimate in-hospital risk standardized mortality rate (RSMR).
The risk-standardized rates of inotropic treatment across hospitals ranged from 0.9% to 44.6% (IQR: 4.3% to 9.2%; median, 6.3%). The researchers identified various hospital patterns based on type of inotropic agents with 29% dobutramine-predominant (IQR: 2.2% to 6.8%; median, 3.7%); 25% dopamine-predominant (IQR: 2.5% to 4.7%; median, 3.3%); 1% milrinone-predominant (IQR: 0.5% to 2%; median, 0.78%); 32% mixed dobutramine and dopamine pattern; and 13% mixed pattern containing all agents.
The HGLM models displayed the best model performance adjusting for patient case mix and individual hospital effect. The receiver operating characteristic curves (ROC) ranged from 0.77 to 0.88. The intraclass correlation coefficients of the HGLM indicated that a substantial proportion of the variance in inotrope use was related to an individual institutional effect. The study did not associate hospital patterns with differences in length of stay or mortality rates.
“Given that hospitalizations for HF are common and that inotropic agents have potential harm in at least some patient populations, the observed variation in patterns of practice highlights the urgent need for greater evidence to guide these care decisions,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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