Haider Warraich
speaker
683 appearances
3 recordings
1 series
first heard Oct 2020
last heard Dec 2021
Haider Warraich’s voice in public audio — every appearance, attributed to the second.
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Appearances
And I think that the decision should be not made lightly.
I think it's complex.
And we need to make sure do patients actually know what this therapy is doing?
There is a lot of variation in heart failure management in general, especially the more advanced patient.
And I think part of it has to do with, are you working in a, you know, a
LVAD or transplant center, where oftentimes physicians are more used to using these medications.
I worked at hospitals that didn't have a transplant program.
There, I felt like the use of inotropics was very, very limited.
And so I rarely saw patients being sent out on them.
Certainly, I think the one very large population that is not a candidate for inotropic therapy are patients with HFPEF, so people who have preserved ejection fraction.
But then when I work more at transplant centers where we use inotropes for other purposes and they're just more available, people are just more to using them for other indications.
I think a lot of times we just have that practice pattern where someone is failing or has advanced cardiac disease.
We often will reach for the inotropes.
But then when the context changes, when the goal might not be to bridge someone to, say,
some type of advanced therapy, but the context might be in the setting of someone with advanced illness and limited lifespan, then we might not make that cognitive adjustment that, oh, this is totally different.
And the trade-offs might be very, very different as well.
So I do think that if you work in a center that does a lot of advanced heart failure care, including LVAD, transplant, et cetera, the clinicians there are just more used to reaching for inotropes in general, but that might not be the case everywhere.
So, I mean, that's a great point.
And I totally agree with you.
I have a very high bar to make the ascertainment that inotropes might be a good or reasonable therapy in someone who is essentially...
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