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Palliative Inotropes — EECC MCQ

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ModerateHeart FailurePalliative InotropesEECC

A 60-year-old man with advanced HFrEF and refractory congestion is started on IV inotropes for haemodynamic support. His medical team discusses the concept of 'palliative inotropes.' What does this mean?

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Correct answer: A — Long-term continuous IV inotrope infusion (typically milrinone or dobutamine) used for symptom palliation in end-stage HF patients who are not candidates for transplant or LVAD, acknowledging that inotropes increase mortality but improve quality of life

In end-stage HF patients who are not candidates for transplant or LVAD (due to comorbidities, frailty, or patient preference), continuous IV inotrope infusion may be used as palliative therapy to improve symptoms and quality of life. The ESC HF Guidelines acknowledge this practice (Class IIb): (1) typically milrinone or dobutamine via a permanent central line; (2) reduces HF hospitalisations and improves functional capacity; (3) accepted that inotropes increase arrhythmic risk and may shorten survival; (4) the decision is a shared one between the patient, family, and HF/palliative care team; (5) ICD deactivation should be discussed (avoiding painful shocks in the dying phase). This represents a palliative care approach where quality of life takes precedence over survival maximisation.

Reference: ESC (2023): HF Guidelines; NICE End-of-life Care