The Impact of Midodrine on Guideline-Directed Medical Therapy in Patients Admitted With Systolic Heart Failure

J Cardiovasc Pharmacol. 2024 Apr 1;83(4):353-358. doi: 10.1097/FJC.0000000000001532.


Midodrine is occasionally used off-label to treat hypotension associated with advanced heart failure (HF); however, its association with changes in prescription of guideline-directed medical therapy (GDMT) is unknown. We sought to evaluate the effect of midodrine on the GDMT prescription pattern and clinical outcomes of patients with decompensated systolic HF. We retrospectively identified 114 patients admitted to our hospital in 2020 with decompensated systolic HF who were prescribed midodrine on discharge and compared them with 358 patients with decompensated systolic HF who were not prescribed midodrine. At 6 months, the midodrine group had more initiation or up-titration of beta blockers, renin-angiotensin-aldosterone system inhibitors, and sodium-glucose cotransporter-2 inhibitors compared with the nonmidodrine group. Survival at 6 months was similar between the 2 groups, but the midodrine group had more frequent rehospitalization for HF. Our findings suggest that midodrine is associated with improved GDMT in patients with decompensated HF but may be associated with worse prognosis.

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Angiotensin Receptor Antagonists / therapeutic use
  • Heart Failure* / chemically induced
  • Heart Failure* / diagnosis
  • Heart Failure* / drug therapy
  • Heart Failure, Systolic* / diagnosis
  • Heart Failure, Systolic* / drug therapy
  • Hospitalization
  • Humans
  • Midodrine* / adverse effects
  • Retrospective Studies
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
  • Stroke Volume


  • Midodrine
  • Sodium-Glucose Transporter 2 Inhibitors
  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists