The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock

Vasopressors and inotropes (Vs/Is) are widely used in the treatment of cardiogenic shock (CS). Despite improvements in hemodynamic variables and end-organ perfusion, these agents have been associated with an increase in mortality, potentially due to the increased risk of tachyarrhythmias—which we hy...

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Autores principales: Ryu, Rachel, Hauschild, Christopher, Bahjri, Khaled, Tran, Huyentran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680500/
https://www.ncbi.nlm.nih.gov/pubmed/36412905
http://dx.doi.org/10.3390/medsci10040064
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author Ryu, Rachel
Hauschild, Christopher
Bahjri, Khaled
Tran, Huyentran
author_facet Ryu, Rachel
Hauschild, Christopher
Bahjri, Khaled
Tran, Huyentran
author_sort Ryu, Rachel
collection PubMed
description Vasopressors and inotropes (Vs/Is) are widely used in the treatment of cardiogenic shock (CS). Despite improvements in hemodynamic variables and end-organ perfusion, these agents have been associated with an increase in mortality, potentially due to the increased risk of tachyarrhythmias—which we hypothesize may be mitigated by beta-blockers (BBs). We conducted a retrospective chart review of patients who received a V/I (dobutamine, milrinone, dopamine, and norepinephrine) for CS. The primary objective was to assess the effect of BB in patients receiving Vs/Is for CS. In our final analysis of 227 patients, those in the BB group were younger, were more likely to have acute coronary syndrome as the reason for admission, had more reduced left ventricular ejection fraction, were more likely to have coronary artery disease and atrial fibrillation as pre-existing co-morbidities, and had a lower rate of in-hospital mortality. Nevertheless, in our multivariable logistic regression analysis, concurrent BB usage with a V/I was not associated with a reduction in in-hospital mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies to optimize inpatient medical therapy, particularly evaluating the combination of V/I and BB, in this high-risk patient population.
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spelling pubmed-96805002022-11-23 The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock Ryu, Rachel Hauschild, Christopher Bahjri, Khaled Tran, Huyentran Med Sci (Basel) Article Vasopressors and inotropes (Vs/Is) are widely used in the treatment of cardiogenic shock (CS). Despite improvements in hemodynamic variables and end-organ perfusion, these agents have been associated with an increase in mortality, potentially due to the increased risk of tachyarrhythmias—which we hypothesize may be mitigated by beta-blockers (BBs). We conducted a retrospective chart review of patients who received a V/I (dobutamine, milrinone, dopamine, and norepinephrine) for CS. The primary objective was to assess the effect of BB in patients receiving Vs/Is for CS. In our final analysis of 227 patients, those in the BB group were younger, were more likely to have acute coronary syndrome as the reason for admission, had more reduced left ventricular ejection fraction, were more likely to have coronary artery disease and atrial fibrillation as pre-existing co-morbidities, and had a lower rate of in-hospital mortality. Nevertheless, in our multivariable logistic regression analysis, concurrent BB usage with a V/I was not associated with a reduction in in-hospital mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies to optimize inpatient medical therapy, particularly evaluating the combination of V/I and BB, in this high-risk patient population. MDPI 2022-11-17 /pmc/articles/PMC9680500/ /pubmed/36412905 http://dx.doi.org/10.3390/medsci10040064 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ryu, Rachel
Hauschild, Christopher
Bahjri, Khaled
Tran, Huyentran
The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title_full The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title_fullStr The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title_full_unstemmed The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title_short The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock
title_sort usage of concomitant beta-blockers with vasopressors and inotropes in cardiogenic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680500/
https://www.ncbi.nlm.nih.gov/pubmed/36412905
http://dx.doi.org/10.3390/medsci10040064
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