ABSTRACT
Chronic heart failure (HF) affects nearly five million individuals and causes more than
200,000 deaths each year (1). Decompensated HF is a rapidly growing problem and
accounts for nearly one million admissions annually in the United States. Despite optimal
medical management, readmission rates remain as high as 30%–60% in the first six months
after an admission for decompensated HF (2). The goals of HF management are to alleviate
symptoms, improve quality of life, and prolong survival. Inotropic therapy remains one
of the most controversial treatment modalities in HF. Despite this, inotropes are often
employed in the acute management of decompensation as bridging strategies to definitive
treatment, and for palliation of symptoms at the end of life (Fig. 1). This chapter reviews the
currently available inotropic agents, their mechanisms of action, trial data regarding their
use in patients with HF, and clinical scenarios where their use might be indicated.
