Clinical Research in Cardiology

, Volume 105, Issue 6, pp 471–481 | Cite as

Long-term intravenous inotropes in low-output terminal heart failure?

  • Wolfgang von ScheidtEmail author
  • Matthias Pauschinger
  • Georg Ertl
Critical Perspective


Intravenous inotropic therapy may be necessary to achieve short-term survival in end-stage heart failure patients with cardiogenic shock or extreme low output and severe organ hypoperfusion. However, mid- or long-term intravenous inotropic therapy is associated with an increased mortality in advanced stage D heart failure patients using β-adrenoceptor agonists (dobutamine) or PDE-3-inhibitors (milrinone). Intermittent levosimendan may evolve as a reasonable therapeutic option. Randomized trials or other meaningful scientific evidence addressing the optimal treatment of exclusively the most threatened subgroup of hospitalized patients with persistent severe organ hypoperfusion are missing, but urgently needed. Despite a lack of other beneficial pharmacological options, the use of long-term intravenous inotropic therapy as a treatment for refractory heart failure or as an obligatory criterion for high urgency (HU) listing of heart transplant candidates with a median waiting time of 66 days in Germany is not based on scientific evidence. In addition, it might create a disincentive to achieve the HU status as well as keeping it, thereby potentially exposing the patient to an unnecessary additional risk. Upcoming new allocation algorithms may possibly help to improve the inadequate present situation. There is need for both, a better definition and a better treatment of high risk terminal heart failure requiring high urgent transplant listing.


Low-output heart failure Inotropic therapy Dobutamine Milrinone Levosimendan High urgency heart transplant listing 


Compliance with ethical standards

Conflict of interest

All authors do not have a conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Wolfgang von Scheidt
    • 1
    Email author
  • Matthias Pauschinger
    • 2
  • Georg Ertl
    • 3
  1. 1.I. Medizinische KlinikKlinikum Augsburg, Herzzentrum Augsburg-SchwabenAugsburgGermany
  2. 2.Medizinische Klinik 8, Kardiologie, Paracelsus Medizinische Privatuniversität, Universitätsklinikum NürnbergNürnbergGermany
  3. 3.Medizinische Klinik und Poliklinik I, Deutsches Zentrum für Herzinsuffizienz - Comprehensive Heart Failure CenterUniversitätsklinikum WürzburgWürzburgGermany

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