Difficult cases in heart failure: Importance of patient selection in the use of intermittent inotrope infusions for advanced heart failure

Intermittent infusions of inotropes have been used with increasing frequency for patients with advanced heart failure (HF). The use of intermittent inotrope infusions remains controversial for several reasons. However, the effect, either positive or negative, of intermittent inotropes in refractory unstable HF patients is not well studied. While prior experience with chronic oral inotropes in stable, advanced HF raises substantial concerns, it may not be directly applicable to a critical evaluation of intermittent inotrope infusions in unstable patients. Further study demonstrating the safety and efficacy of this approach in these patients is imperative. The uncertainties surrounding this therapy, mandate the selection of appropriate candidates be made with substantial care. We report three patients with advanced HF despite conventional therapy, in whom intermittent inotropes were considered. These cases illustrate that this therapy can be avoided in many patients by acceleration of conventional medications, patient education, and aggressive follow up intermittent. However, outpatient inotrope infusions may be helpful in highly selected patients with refractory, unstable HF.