Use of Midodrine in Heart Failure: Two Case Reports and a Review of the Literature

Hajjiah, Adnan; Maadarani, Ossama; Bitar, Zouheir; Hanna, Boutros; Elshabasy, Ragab Desouky; Abdelfatah, Mohamed M.; Gohar, Mohammad

doi:10.12890/2022_003246

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Firstly, in terms of hospitalization-related outcomes, the midodrine group exhibited fewer ER visits but more ICU stays, respiratory failures, all hospitalizations, and mortality. Until now, only case reports ( Hajjiah et al, 2022 ) or case series ( Zakir et al, 2009 ) have addressed midodrine usage in heart failure. In one case series ( n = 10) ( Zakir et al, 2009 ), midodrine usage was associated with fewer total hospital admissions and total hospital days.…”

Section: Discussionmentioning

confidence: 99%

“…However, a poster presentation ( Scoma et al, 2021 ) indicated significantly higher all-cause mortality at 6 months following hospitalization in the midodrine group compared to the non-midodrine group (HR:6.7, 95% CI:5.2%–8.5%). There have been some recent case reports showing potential benefits (at least in terms of blood pressure improvement and a higher likelihood of GDMT) ( Hajjiah et al, 2022 ; Shiu et al, 2022 ). However, these studies were only case series with small sample sizes, lacking matched controls, and limited to short-term follow-ups.…”

Section: Introductionmentioning

confidence: 99%

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Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Wu,

Chen,

Tsai

2024

Front. Pharmacol.

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Background: Heart failure with reduced ejection fraction (HFrEF) poses significant health risks. Midodrine for maintaining blood pressure in HFrEF, requires further safety investigation. This study explores midodrine’s safety in HFrEF through extensive matched analysis.Methods: Patients with HFrEF (LVEF <50%) without malignancy, non-dialysis dependence, or non-orthostatic hypotension, were enrolled between 28 August 2013, and 27 August 2023. Propensity score matching (PSM) created 1:1 matched groups. Outcomes included mortality, stage 4 and 5 chronic kidney disease (CKD), emergency room (ER) visits, intensive care unit (ICU) admissions, hospitalizations, and respiratory failure. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for each outcome, and Kaplan-Meier survival analysis was performed. Subgroup analyses were conducted based on gender, age (20-<65 vs. ≥65), medication refill frequency, and baseline LVEF.Results: After 1:1 PSM, 5813 cases were included in each group. The midodrine group had higher risks of respiratory failure (HR: 1.16, 95% CI: 1.08–1.25), ICU admissions (HR: 1.14, 95% CI: 1.06–1.23), hospitalizations (HR: 1.21, 95% CI: 1.12–1.31), and mortality (HR: 1.090, 95% CI: 1.01–1.17). Interestingly, midodrine use reduced ER visits (HR: 0.77, 95% CI: 0.71–0.83). Similar patterns of lower ER visit risk and higher risks for ICU admissions, respiratory failure, and overall hospitalizations were observed in most subgroups.Conclusion: In this large-scale study, midodrine use was associated with reduced ER visits but increased risks of respiratory failure, prolonged ICU stays, higher hospitalizations, and elevated mortality in HFrEF patients. Further research is needed to clarify midodrine’s role in hemodynamic support and strengthen existing evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Wu,

Chen,

Tsai

2024

Front. Pharmacol.

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Dobutamine/levosimendan/norepinephrine

2022

Reactions Weekly

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Use of midodrine in heart failure: a review

Gautam

Lamichhane

Sharma

et al. 2023

Annals of Medicine &Amp; Surgery

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Heart failure is a global health concern, affecting millions of individuals worldwide. Midodrine, an alpha-1 receptor agonist, might be a potential treatment option for patients with heart failure and concurrent hypotension. This review provides a comprehensive summary of the existing literature on the use of midodrine in heart failure patients, focusing on its pharmacology, epidemiology, and public health impact. Guideline-directed medical therapy (GDMT) is essential in heart failure management, but hypotension may limit its initiation or up-titration. Studies have shown that midodrine can improve blood pressure, reduce the need for vasopressor support, and enable the prescription of GDMT in patients who are intolerant to it due to hypotension. However, there are concerns over increased all-cause mortality in some studies, small sample sizes, and nonrandomized study designs in others. Further research, including large-scale randomized controlled trials and long-term follow-up studies, is needed to better understand the risks and benefits of midodrine use in heart failure patients, particularly in relation to GDMT. Clinicians should consider the potential advantages of midodrine against the limited evidence and potential risks before incorporating it into their clinical practice for heart failure treatment.

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Use of Midodrine in Heart Failure: Two Case Reports and a Review of the Literature

Cited by 3 publications

References 12 publications

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study

Dobutamine/levosimendan/norepinephrine

Use of midodrine in heart failure: a review

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