RT Journal Article SR Electronic T1 Midodrine in end-stage heart failure JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP e86 OP e87 DO 10.1136/bmjspcare-2020-002369 VO 13 IS e1 A1 Gonzalez-Cordero, Ariel A1 Ortiz-Troche, Stephanie A1 Nieves-Rivera, Juan A1 Mesa-Pabón, Marcel A1 Franqui-Rivera, Hilton YR 2023 UL http://spcare.bmj.com/content/13/e1/e86.abstract AB It is estimated that 5% of patients with heart failure (HF) will progress to end-stage disease refractory to medical therapy and might require prolonged hospitalisation with inotropic support. We present the case of a patient with end-stage HF who was admitted with cardiogenic shock. During his hospitalisation, he required prolonged intravenous vasopressor therapy due to refractory hypotension. He did not qualify for heart transplantation or left ventricular-assist device strategies. Midodrine was started as a last resort attempt to wean off vasopressors. After 5 days of therapy, the patient was weaned entirely off vasopressors and was discharged home for hospice care. By the time of discharge, he was tolerating low-dose carvedilol along with midodrine. We propose midodrine as a reasonable alternative for patients with end-stage HF with reduced ejection fraction and refractory hypotension, who are dependent on intravenous vasoactive drugs and are not candidates for advanced HF therapies.