Timing of inotropic support is associated with mortality in patients with acute decompensation

Authors: John C. Greenwood, Charith Ratnayake, Moizza Shabbir, Samantha Opitz, David H. Jang, Wook-Jin Choi, Nova L. Panebianco, Frances S. Shofer, John G. T. Augoustides, Jan Bakker, Joyce W. Wald & Benjamin S. Abella

A retrospective analysis from the University of Pennsylvania evaluated the association between timing of inotropic therapy and mortality in patients with advanced heart failure–related cardiogenic shock meeting SCAI stage C criteria. Among 138 patients included from a cardiogenic shock registry, initiation of inotropes ≥8 hours after shock onset was compared with earlier initiation within 8 hours. The primary outcome was 28-day mortality.

Delayed inotropic support was associated with higher 28-day mortality compared with early initiation (32% vs. 17%, p = 0.031), with increased odds of death at both 4 and 8 hours after shock onset. Patients receiving delayed therapy more frequently presented with hypotension and experienced longer delays to echocardiography and pulmonary artery catheterisation, whereas early-treated patients more often exhibited signs of hypoperfusion and elevated lactate. These findings suggest that earlier initiation of inotropes may be associated with improved short-term outcomes and underscore the value of early shock identification using structured classification tools, such as the SCAI criteria.