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Volume 23 - Issue 4, October-December 2021
SHORT REPORTS
POTENTIAL ROLE OF CONCOMITANT BETA-BLOCKERS WITH VASOPRESSORS AND INOTROPES IN CARDIOGENIC SHOCK
RYU RACHEL, HAUSCHILD CHRISTOPHER, BAHJRI KHALED, TRAN HUYENTRAN


Objective: Vasopressors and inotropes (V/I) are widely used in the treatment of cardiogenic shock (CS). Despite improvement of hemodynamic variables and end-organ perfusion, these agents have been associated with increases in mortality. We hypothesize that beta-blockers (BB) may mitigate the harmful side effects associated
with use.

Method: We conducted a retrospective chart review of patients who received a V/I (dobutamine, milrinone, dopamine, and norepinephrine). The primary objective was to assess for the role of BB in patients receiving V/I for CS. Descriptive statistics in the form of mean and standard deviation were used for quantitative variables, and number and percentage for qualitative variables. The Chi-square test or Fisher’s exact tests were used to assess the association of different variables with mortality status.

Results: Of 227 patients in our final analysis, 66% were male, 41% were Hispanic, the average age was 63.4 ±15.1 years, and the inpatient mortality rate was 19%. When comparing between those that received BB vs those that did not, the mean HR was significantly higher in those that received BB (90 v 82 bpm, p = 0.002), though the BP was not significantly different (Table 2). At maximum V/I doses, the SBP was significantly lower in those that received BB (99 vs 111 mmHg, p <0.001), but not the HR on max V/I doses nor the DBP. Upon exclusion of those on norepinephrine or dopamine >5 mcg/kg/min, and after adjustment for baseline HR, the multivariate logistic regression did not show a difference in mortality between those that received BB vs those that did not (44.4 vs 55.6%, p = 0.637).

Conclusions: Based on our study, concomitant BB use with a V/I in CS patients was not associated with mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies on how to optimize inpatient medical therapy in this high-risk patient population.

CARDIOGENIC SHOCK – CARDIOLOGY – HEART FAILURE – INOTROPES – VASOPRESSORS



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