Aims Studies in cardiogenic shock (CS) often have a heterogeneous population of patients, including those with acute myocardial infarction and acute decompensated heart failure (ADHF‐CS). The therapeutic profile of milrinone may benefit patients with ADHF‐CS. We compared the outcomes and haemodynamic trends in ADHF‐CS receiving either milrinone or dobutamine. Methods and results Patients presenting with ADHF‐CS (from 2014 to 2020) treated with a single inodilator (milrinone or dobutamine) were included in this study. Clinical characteristics, outcomes, and haemodynamic parameters were collected. The primary endpoint was 30 day mortality, with censoring at the time of transplant or left ventricular assist device implantation. A total of 573 patients were included, of which 366 (63.9%) received milrinone and 207 (36.1%) received dobutamine. Patients receiving milrinone were younger, had better kidney function, and lower lactate at admission. In addition, patients receiving milrinone received mechanical ventilation or vasopressors less frequently, whereas a pulmonary artery catheter was more frequently used. Milrinone use was associated with a lower adjusted risk of 30 day mortality (hazard ratio = 0.52, 95% confidence interval 0.35–0.77). After propensity‐matching, the use of milrinone remained associated with a lower mortality (hazard ratio = 0.51, 95% confidence interval 0.27–0.96). These findings were associated with improved pulmonary artery compliance, stroke volume, and right ventricular stroke work index. Conclusions The use of milrinone compared with dobutamine in patients with ADHF‐CS is associated with lower 30 day mortality and improved haemodynamics. These findings warrant further study in future randomized controlled trials.

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Background: Heart failure (HF) is a common reason for admission to the cardiac intensive care unit. We sought to identify the role of an HF consultation service in improving the management of this patient population. Methods: We identified all adult patients admitted to the cardiac intensive care unit (2014)(2015) at the University Health Network with a diagnosis of acute decompensated HF AE cardiogenic shock (CS). Clinical characteristics and course were recorded. We calculated a propensity scoreeadjusted association between HF consultation and in-hospital mortality. Results: A total of 285 unique patients were identified in our cohort. Of these, 82 (28.7%) died. A total of 150 patients (52.6%) were comanaged by an HF service, and 135 patients (47.3%) were not. Ethics Statement:The research reported has adhered to the relevant ethical guidelines.