Inotropes can help heart failure symptoms in the short term but are not a life-saving therapy1
For patients with advanced heart failure, the likelihood of long-term survival without an LVAD or a heart transplant is extremely low.
Due to poor outcomes associated with long-term inotrope use when a transplant or LVAD is an option, the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Failure Society of America (HFSA) have issued a 3 Harm recommendation. This indicates that the risks of long-term inotrope therapy far outweigh the benefits if a transplant or LVAD if available.2
Patients on long-term inotrope support have a median survival of under a year1
Without an LVAD or transplant, advanced heart failure patients would not be expected to survive beyond 9 months.3,4,*
LVAD therapy receives a 1A Recommendation from the U.S. joint societies5
The joint committees of the AHA recently evaluated the data on LVAD patient outcomes and granted a 1A Recommendation for heart failure patients who are dependent on intravenous inotropes or cannot be weaned from temporary mechanical circulatory support (MCS).
Section 8.4 Mechanical Circulatory Support
“Recommendations for mechanical circulatory support referenced studies that support the recommendations are summarized in the Online Data Supplements”
1A Recommendation is the strongest Class of Recommendation (COR) and the highest level of evidence (LOE). This means that benefits are supported by strong data and far outweigh the risks.
See a Summary of the 1A Recommendation
Timely patient identification and evaluation for advanced therapies are critical
If your patient experiences any of the following, refer them to a heart failure specialist for evaluation for advanced heart failure therapies, including LVAD therapy.
Timely Referral for LVAD Therapy “Rule of 3”6
Repetitive hospitalizations for heart failure (2 or more events in a year)
Staircase diuretic requirements over time to maintain clinical stability (e.g., an increase of oral loop diuretics therapy by 50% in the preceding 6 months)
Intolerance to neurohormonal therapy with onset of cardio-renal perturbation
Left Ventricular Assist Devices: A primer for the general cardiologist
Consider HeartMate 3 LVAD as a solution for patients with advanced heart failure who do not respond to medical treatments
The HeartMate 3™ LVAD has significantly advanced the field of LVAD therapy, setting the standard with innovation and exceptional clinical outcomes. Its Full MagLev™ Flow Technology ensures gentle blood handling, minimizing complications and reducing hemocompatibility-related adverse events (HRAEs).**
HeartMate 3 LVAD, a proven long-term, life-extending therapy for advanced heart failure patients.
Median survival
exceeding 5 years3
58.4% survival at 5 years3
Reduction in HRAE-related mortality3
** Key adverse events include pump thrombosis, stroke and gastrointestinal (GI) bleeding.
For more information about the HeartMate 3 LVAD, see the clinical evidence or ask a clinical specialist.
Left Ventricular Assist Devices at the Crossroad of Innovation in Advanced Heart Failure: Journal of Cardiac Failure
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Clinics are listed in order of geographic proximity from the information entered in the locator. Abbott does not endorse any of the clinics on this locator, but merely provides them as a courtesy to patients. Nor does Abbott represent that this is a full list of clinics in a particular location. Though Abbott attempts to regularly update the locator, the locator may not have the latest information regarding the clinic or provider, or availability of product. The clinics are included in the locator because they are certified as a HeartMate LVAD implanting center, have ordered at least one HeartMate LVAD in the last 12 months, and have all HeartMate LVAD device-related equipment required for patient management. The number of orders has been validated; the number of implants has not been validated. This locator includes US clinics only. No clinics or healthcare professionals (HCPs) have paid or received a fee to be listed, but some HCPs within the clinics on this locator may purchase products from Abbott, provide consulting services to Abbott, and/or may have a financial relationship with Abbott. The locator is not meant to be an endorsement for any particular clinic, nor does it represent the qualifications of the HCPs at the clinic. Note that Abbott is a medical device manufacturer and cannot provide medical advice.
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Patient Education for Heart Failure
A resource to help patients learn more about heart failure and understand how LVAD therapy can save their life.
*Patients on inotropes who did not receive a transplant or left ventricular assist device.
References
- Sami F, Acharya P, Noonan G, et al. Palliative inotropes in advanced heart failure: comparing outcomes between milrinone and dobutamine. J Card Fail. 2022;28(12):1683-1691
- Writing Committee Members; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Card Fail. 2022;28(5):e1-e167
- Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. September 8, 2022. doi:10.1001/jama.2022.16197
- Hashim T, Sanam K, Revilla-Martinez M, et al. Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure. Circ Heart Fail. 2015;8(5):880-886
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):e263-e421. doi:10.1016/j.jacc.2021.12.01
- Mehra MR, Gustafsson F. Left ventricular assist devices at the crossroad of innovation in advanced heart failure. J Card Fail. 2021;27(11):1291-1294. doi:10.1016/j.cardfail.2021.06.003
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