The characterization of concomitant beta-blocker usage with vasopressors and inotropes in cardiogenic shock

Abstract Purpose: Vasopressors and inotropes (V/I) are widely used in the treatment of cardiogenic shock (CS). Despite improvement of hemodynamic variables and end-organ perfusion, these agents have been associated with increases in mortality, potentially due to the increased risk of tachyarrhythmias—which may be mitigated by beta-blockers (BB). Methods: We conducted a retrospective chart review of patients who received a V/I (dobutamine, milrinone, dopamine, and norepinephrine). The primary objective was to assess for the role of BB in patients receiving V/I for CS. Descriptive statistics in the form of mean and standard deviation were used for quantitative variables, and number and percentage for qualitative variables. The Chi-square test or Fisher's exact tests were used to assess the association of different variables with mortality status. Results: When comparing between those that received BB vs those that did not, the mean HR was significantly higher in those that received BB (90 v 82 bpm, p=0.002). At maximum V/I doses, the SBP was significantly lower in those that received BB (99 vs 111 mmHg, p<0.001). Upon exclusion of those on high doses of V/I, the multivariate logistic regression did not show a difference in mortality between those that received BB vs those that did not (44.4 vs 55.6%, p=0.637).Conclusions: Based on our study, concomitant BB use with a V/I in CS patients was not associated with mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies to optimize inpatient medical therapy in this high-risk patient population.