Desospitalização de paciente paliativo com insuficiência cardíaca avançada e o uso de inotrópicos: Protocolo assistencial do Hospital de Clínicas da Universidade Federal de Uberlândia

Abstract

Heart failure is a clinical syndrome characterized by a progressive deterioration of heart function and, consequently, of the individual who presents with it. Patients reach an advanced level of heart impairment when they remain highly symptomatic despite the use of optimized standard therapies, potentially progressing to a point where invasive therapies are no longer possible. At this point, care becomes complex and should focus more on improving quality of life rather than in curative goals. Thus, this study aimed to conduct a systematic review of the indications for therapies in this clinical context, especially inotropes, and to develop a protocol to guide appropriate practices to facilitate the definition of clinical conduct. This was done through an observational analysis of 44 articles found in online databases, published from 2015 to 2025 and considered relevant to the proposed topic. From this, the great importance of palliative measures in the care of these patients was observed as a way to control symptoms, including the use of inotropes for this same purpose. This is because most of the evaluated research showed that the use of these medications resulted in a reduction in the number and duration of hospitalizations; a reduction in symptoms with improved functionality and a reduction in brain natriuretic peptide; without leading to increased mortality or significant side effects. Therefore, considering the beneficial effects seen in these studies, it was possible, based on their records, to define guidelines for the palliative management of these patients and for the prescription of inotropes such as Dobutamine and Levosimendan. Finally, despite the existence of some evidence supporting these practices, further research on this topic is still essential, since the data obtained so far come from evaluations of small and heterogeneous population samples. This fact does not invalidate the guidelines described throughout the text, but rather emphasizes and encourages the continuation of scientific production on this subject.