Abstract 4147683: The Impact of Midodrine on Heart Failure Outcomes: Emergency Visits, Mortality, and Complications

Background: Midodrine, an FDA-approved peripheral alpha1-adrenergic agonist for treating orthostatic hypotension, is also used off-label to manage hypotension in patients with advanced heart failure (HF). Hypotension, whether due to HF itself or as a side effect of its treatment, often restricts the optimization of medical therapy in these patients. By increasing baseline blood pressure, midodrine can enhance the tolerance of HF medications, potentially improving patient outcomes. The use of midodrine is limited due to the risk of supine hypertension, making it crucial to investigate its effects in this patient population. Methods: This study utilized data from the US Collaborative Network, focusing on heart failure patients with a Left Ventricular Ejection Fraction (LVEF) of less than 50%. It compared outcomes between patients treated with midodrine (22,178 patients) and those not treated (376,686 patients). After Propensity Score Matching (PSM), each group consisted of 21,893 matched patients. The outcomes measured included emergency department visits, mortality, shock, and CHF exacerbation, aiming to assess the impact of midodrine on these aspects of heart failure management. Results: Midodrine treatment was associated with significant improvements in key outcomes for heart failure patients: it reduced emergency department visits (OR: 0.68, 95% CI: 0.57-0.81, p<0.001), lowered mortality rates (OR: 0.75, 95% CI: 0.65-0.87, p<0.001), decreased occurrences of shock (OR: 0.59, 95% CI: 0.46-0.76, p<0.001), and mitigated CHF exacerbation (OR: 0.82, 95% CI: 0.74-0.91, p<0.001), underscoring the potential benefits of midodrine in managing heart failure. Conclusion: The study demonstrates that midodrine treatment in heart failure patients significantly reduces emergency department visits, mortality, shock, and CHF exacerbation, highlighting its potential as a beneficial off-label option. These findings suggest an important role for midodrine in enhancing the management and outcomes of patients with advanced heart failure.