Evidence map›Paper›PMID 33083701›Full record

ArticleMayo Clinic proceedings. Innovations, quality & outcomes2020

Expected vs Actual Outcomes of Elective Initiation of Inotropic Therapy During Heart Failure Hospitalization.

David Snipelisky, Marat Fudim, Antonio Perez, Matthew Nayor, Natasha M Lever, David S Raymer, Andrew N Rosenbaum, Omar AbouEzzeddine, Adrian F Hernandez, Lynne Warner Stevenson and 1 more

Abstract read
In one paragraph

Article in Mayo Clinic proceedings. Innovations, quality & outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

11 authors.

David SnipeliskyDivision of Advanced Heart Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Marat FudimDivision of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
Antonio PerezSection of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Matthew NayorCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Natasha M LeverCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
David S RaymerDivision of Cardiology, University of Colorado School of Medicine, Aurora.
Andrew N RosenbaumDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Omar AbouEzzeddineDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Adrian F HernandezDivision of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
Lynne Warner StevensonDivision of Cardiovascular Medicine, Vanderbilt University, Nashville, TN.
Lauren G GilstrapDartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH.

Funding

Harvard Regional Clinical Center of the NHLBI Heart Failure NetworkU10HL110337 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI GIVERTZ, MICHAEL M, LEWIS, GREGORY DYER · 2012 to 2018
$3.5M
Metabolic Signatures of Impaired Cardiorespiratory Fitness: Correlates, Prognostic Significance and Modulation with Exercise TrainingK23HL138260 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NAYOR, MATTHEW G. · 2017 to 2021
$998k
The Impact of Quality Metrics on Outcomes Among Elderly Heart Failure PatientsK23HL142835 · NHLBI · DARTMOUTH-HITCHCOCK CLINIC · PI GILSTRAP, LAUREN GRAY · 2018 to 2022
$831k
NHLBI NIH HHS K23 HL138260NHLBI NIH HHS K23 HL142835NHLBI NIH HHS U10 HL110337
6 · The paper itself

Abstract

objectiveTo describe the intent and early outcomes of elective inotrope use during heart failure hospitalization. PATIENTS AND

methodsA prospective multisite design was used to collect data for hemodynamically stable patients started electively on inotrope therapy between January 1 and August 31, 2018. We prospectively recorded data when intravenous inotropic therapy was initiated, including survey of the attending cardiologists regarding expectations for the clinical course. Patients were followed up for events through hospital discharge and an additional survey was administered at the end of hospitalization.

resultsFor the 92 patients enrolled, average age was 60 years and ejection fraction was 24%±12%. At the time of inotrope initiation, attending heart failure cardiologists predicted that 50% (n=46) of the patients had a "high or very high" likelihood of becoming dependent on intravenous inotropic therapy and 58% (n=53) had a "high" likelihood of death, transplant, or durable ventricular assist device placement within the next 6 months. Provider predictions regarding death/hospice or need for continued home infusions were accurate only 51% (47 of 92) of the time. Only half the patients (n=47) had goals-of-care conversations before inotrope treatment initiation.

conclusionMore than half the patients (51 of 92) electively started on inotrope treatment without present or imminent cardiogenic shock ultimately required home inotrope therapy, died during admission, or were discharged with hospice. Heart failure clinicians could not reliably identify those patients at the time of inotrope therapy initiation and goals-of-care discussions were not frequently performed.

Indexed as

ACEi, angiotensin-converting enzyme inhibitorARB, angiotensin receptor blockerARNI, angiotensin receptor neprilysin inhibitorESCAPE, Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization EffectivenessHF, heart failureIIT, intravenous inotropic therapyIQR, interquartile rangeVAD, ventricular assist device

Identifiers

PMID33083701
PMCPMC7557209

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.