Patient selection: hospitalized patient with end-stage heart failure receiving inotropes
Goals:
(1) Discontinue the use of inotropes
(2) Discharge the patient on oral medications.
Criteria for inotrope dependence:
(1) The patient is receiving optimized treatment of heart failure.
(2) The patient is receiving optimized treatment of all other reversible comorbid conditions.
(3) Repeated efforts to discontinue inotropes result in significant clinical deterioration within minutes or hours.
(4) The clinical assessment by a skilled clinician is that the patient would be unable to survive inotrope withdrawal.
Signs and symptoms of clinical deterioration:
(1) worsening hypotension
(2) worsening level of consciousness and/or mental status
(3) deterioration in renal function (increasing serum creatinine, decreasing urine output)
(4) deterioration in levels of oxygenation
(5) worsening dyspnea
(6) increasing weakness
(7) progressive weight gain from edema
