Abstract
The thoughtful analysis by Hershberger of the experience with continuous intravenous inotropic therapy provides timely information as we begin to revise routes through the end stages of heart failure. The success of therapies for myocardial infarction and for mild-moderate heart failure has led to the expansion of a compromised population that has progressed beyond current trial evidence. Although “inotrope dependence” defies objective definition, such definition is increasingly needed to allow refinement and ranking of other options. The expectation of imminent deterioration undermines the posture of equipoise, from which tentative new steps will be taken.
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