Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging. The present consensus, derived by a panel meeting of experts from 21 countries, aims at addressing this very issue in the setting of both acute and advanced heart failure.

1st Department of Cardiology Medical University of Gdansk Gdansk Poland

2nd Department of Cardiology Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

2nd Department of Cardiology Attikon University Hospital National and Kapodistrian University of Athens Athens Greece; Emergency Department Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

Advanced Heart Failure and Transplantation Center Department of Cardiology Ljubljana University Medical Center Ljubljana Slovenia

Aristotle University of Thessaloniki Thessaloniki Greece

Cardiology Dept Rigshospitalet University of Copenhagen Copengahen Denmark

Cardiovascular Center Na Homolce Hospital Prague Czech Republic

Centro Cardiologico Monzino IRCCS Milan Italy; Dept of Clinical Sciences and Community Health Cardiovascular Section University of Milan Milan Italy

Charité University Medicine Berlin Campus Virchow Klinikum Department of Cardiology Germany; BCRT Berlin Institute of Health for Center for Regenerative Therapies Berlin Germany

Complexo Hospitalario Universitario de A Coruña A Coruña Spain

Critical Care Proprietary Products Orion Pharma Espoo Finland

Department for Cardiovascular Diseases University Hospital Center Zagreb University of Zagreb Zagreb Croatia

Department of Anaesthesiology and Critical Care Medicine AP HP Saint Louis and Lariboisière University Hospitals and INSERM UMR S 942 Paris France

Department of Anesthesiology Almazov National Medical Research Center Saint Petersburg Russia

Department of Cardiology Dokuz Eylul University Faculty of Medicine Izmir Turkey

Department of Cardiology General Hospital Sismanogleio Amalia Fleming Greece

Department of Cardiology Heart and Lung Center University of Helsinki and Helsinki University Hospital Helsinki Finland

Department of Cardiology Myokardiale Energetik und Metabolismus Research Unit Medical University Graz Austria

Department of Cardiology North Estonia Medical Center Tallinn Estonia

Department of Cardiology S7 Jorvi Hospital Espoo Finland; Critical Care Proprietary Products Orion Pharma Espoo Finland

Department of Cardiovascular Respiratory Nephrology Anesthesiology and Geriatric Sciences 'La Sapienza' University of Rome Rome Italy

Department of Cardiovascular Sciences Ospedali Riuniti Ancona Italy

Department of Experimental Diagnostic and Specialty Medicine S Orsola Malpighi Hospital University of Bologna Italy

Department of Intensive Care Experimental Laboratory of Intensive Care Erasme Hospital Université Libre de Bruxelles Bruxelles Belgium

Emergency Department Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

Emergency Medicine University of Helsinki Helsinki University Hospital Helsinki Finland

Heart and Vascular Center Semmelweis University Budapest Hungary

Heart Diseases Institute Hospital Universitari de Bellvitge IDIBELL University of Barcelona L'Hospitalet de Llobregat Spain

Heart Failure and Familial Cardiopathies Unit Cardiology Department Hospital Universitario Virgen de la Victoria Málaga Spain

Intensive Care Dpt Consorci Sanitari Integral University of Barcelona Barcelona Spain; Cardiology Department Hospital Sanitas CIMA Barcelona Spain

Jesselson Integrated Heart Center Shaare Zedek Medical Center Jerusalem Israel

Medizinische Klinik Mitte Schwerpunkte Kardiologie und Internistische Intensivmedizin Klinikum Dortmund gGmbH Dortmund Germany

Service de Médecine Intensive Adulte et Centre des Brûlés Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine Lausanne Switzerland

Transplant Institute Sahlgrenska University Hospital Gothenburg Sweden

Universitätsklinik für Innere Medizin 3 Medizinsche Universität Innsbruck Austria

University of Cyprus Medical School Nicosia Cyprus; 2nd Department of Cardiology Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

Int J Cardiol. 2021 Sep 1;338:153. doi: 10.1016/j.ijcard.2021.05.057. PubMed

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