{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:35:43Z","timestamp":1771472143639,"version":"3.50.1"},"reference-count":14,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Vasopressors and inotropes (Vs\/Is) are widely used in the treatment of cardiogenic shock (CS). Despite improvements in hemodynamic variables and end-organ perfusion, these agents have been associated with an increase in mortality, potentially due to the increased risk of tachyarrhythmias\u2014which we hypothesize may be mitigated by beta-blockers (BBs). We conducted a retrospective chart review of patients who received a V\/I (dobutamine, milrinone, dopamine, and norepinephrine) for CS. The primary objective was to assess the effect of BB in patients receiving Vs\/Is for CS. In our final analysis of 227 patients, those in the BB group were younger, were more likely to have acute coronary syndrome as the reason for admission, had more reduced left ventricular ejection fraction, were more likely to have coronary artery disease and atrial fibrillation as pre-existing co-morbidities, and had a lower rate of in-hospital mortality. Nevertheless, in our multivariable logistic regression analysis, concurrent BB usage with a V\/I was not associated with a reduction in in-hospital mortality. Our present study sheds light on the importance and urgency of large, carefully designed clinical studies to optimize inpatient medical therapy, particularly evaluating the combination of V\/I and BB, in this high-risk patient population.<\/jats:p>","DOI":"10.3390\/medsci10040064","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T06:02:29Z","timestamp":1668751349000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Usage of Concomitant Beta-Blockers with Vasopressors and Inotropes in Cardiogenic Shock"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9593-8928","authenticated-orcid":false,"given":"Rachel","family":"Ryu","sequence":"first","affiliation":[{"name":"College of Pharmacy, Western University of Health Sciences, 309 E. Second Street, Pomona, CA 91766, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Hauschild","sequence":"additional","affiliation":[{"name":"Loma Linda University Medical Center, 11223 Campus Street, Loma Linda, CA 92350, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Bahjri","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Loma Linda University, 24745 Stewart Street, Loma Linda, CA 92350, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huyentran","family":"Tran","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Loma Linda University, 24745 Stewart Street, Loma Linda, CA 92350, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Writing Committee Members, and ACC\/AHA Joint Committee Members (2022). 2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure. J Card Fail., 28, e1\u2013e167.","DOI":"10.1016\/j.cardfail.2022.03.346"},{"key":"ref_2","first-page":"e232","article-title":"Contemporary Management of Cardiogenic Shock: A Scientific Statement from the American Heart Association","volume":"136","author":"Katz","year":"2017","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11795468211049449","DOI":"10.1177\/11795468211049449","article-title":"Predictors of In-hospital Mortality in Cardiogenic Shock Patients on Vasoactive or Inotropic Support","volume":"15","author":"Nandkeolyar","year":"2021","journal-title":"Clin Med. Insights Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s13054-021-03706-2","article-title":"Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: A subgroup analysis of the DOREMI trial","volume":"25","author":"Mathew","year":"2021","journal-title":"Crit Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"R99","DOI":"10.1186\/cc6976","article-title":"Combined milrinone and enteral metoprolol therapy in patients with septic myocardial depression","volume":"12","author":"Schmittinger","year":"2008","journal-title":"Crit Care."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s40261-015-0325-3","article-title":"Combination therapy with milrinone and esmolol for heart protection in patients with severe sepsis: A prospective, randomized trial","volume":"35","author":"Wang","year":"2015","journal-title":"Clin. 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Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jchf.2020.09.005","article-title":"A Standardized and Comprehensive Approach to the Management of Cardiogenic Shock","volume":"8","author":"Tehrani","year":"2020","journal-title":"JACC Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.jchf.2015.03.008","article-title":"Effects of beta-blocker withdrawal in acute decompensated heart failure: A systematic review and meta-analysis","volume":"3","author":"Prins","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_11","first-page":"S2","article-title":"Ivabradine has no Effect on Cardiac Arrhythmias Observed During Dobutamine Infusion: A Comparative Study with \u03b2 Blocker Therapy","volume":"62","author":"Mert","year":"2013","journal-title":"J. Am. Coll. 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Pol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/CCM.0b013e31820a91ed","article-title":"Beneficial association of \u03b2-blocker therapy on recovery from severe acute heart failure treatment: Data from the Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support trial","volume":"39","author":"Link","year":"2011","journal-title":"Crit Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.acvd.2019.04.004","article-title":"Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission","volume":"112","author":"Delmas","year":"2019","journal-title":"Arch. Cardiovasc Dis."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/10\/4\/64\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:20:10Z","timestamp":1760145610000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/10\/4\/64"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,17]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["medsci10040064"],"URL":"https:\/\/doi.org\/10.3390\/medsci10040064","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,17]]}}}