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. Author manuscript; available in PMC: 2011 Apr 13.
Published in final edited form as: Circulation. 2010 Apr 13;121(14):1655–1660. doi: 10.1161/CIRCULATIONAHA.109.899294

Figure 2.

Figure 2

Recommended approach to use of inotropic support in patients hospitalized with acute HF exacerbation. As long as patients appear clinically well-perfused, usually with a systolic blood pressure (BP) > 80, inotropes provide no outcome benefit and subject patients to significant risks of arrhythmia, remodeling and death. Well-perfused patients with impaired functional capacity and frequent hospitalizations for HF exacerbation may benefit from digoxin. In hospitalized patients with worsening cardiorenal syndrome despite intravenous diuretic and vasodilator therapy, it is reasonable to add an inotrope in an attempt to acutely rescue renal function. If patients are hospitalized with clinical evidence of shock, inotropic support is clearly indicated as a temporary measure until stabilized on oral agents, or bridged to transplant or mechanical assist device. Continuous home inotropes may also be considered for end stage patients as a palliative measure.