INOTROPIC AGENTS IN OLDER PATIENTS WITH CHRONIC HEART-FAILURE - CURRENT PERSPECTIVES

Until recently, inotropic therapy hers been regarded as the most direc t remedy for the left ventricular systolic dysfunction that often unde rlies the development of heart failure. Nevertheless, all the agents w ith significant inotropic properties that have been evaluated to date (such as beta adrenergic stimulants, phosphodiesterase inhibitors, and high-dose vesnarinone) showed significant increases in mortality with long-term administration. However, it is noteworthy that the particip ants in trials to evaluate inotropic therapy were not representative o f geriatric heart failure patients for age, gender, and comorbidity. T hus, results from these studies must be interpreted cautiously when tr eatment for chronic heart failure must be applied to elderly subjects. Al present, digitalis is the only inotropic agent recommended for lon g-term treatment, because it improves symptoms and prevents disease pr ogression through neurohormonal and baroreceptor mechanisms; neverthel ess. its long-term safety is still undetermined. The role of low-dose vesnarinone, pimobendan and ibopamine, which share neurohormonal, rath er than inotropic, mechanisms sf action, is still under investigation. Pending the definition of these issues, ACE-inhibitors and diuretics remain the mainstay of therapy for chronic heart failure.