## 4 Discussion  
It is clear from the obtained ranking results that both acute and chronic HFrEF patient groups would most likely benefit from dopamine, as it was consistently ranked highest on both lists. For the acute HFrEF group, noradrenaline was a very close second. Thus, it might be fair to say that under most circumstances, depending on the patient's clinical presentation, a choice between either of them should be used as the go-to initial treatment, depending of course on the clinical presentation. However, when it comes to chronic patients, we can see that noradrenaline drops down to the fourth ranking and milrinone comes in at a close second place, with the same choice considerations as before still withstanding. In contrast, milrinone was ranked as the last choice in the acute group. Dobutamine seems to consistently rank in third place, suggesting that it is an all-around \"balanced\" drug for this study. Lastly, adrenaline consistently ranked much lower than other inotrope alternatives in both the results (4 th and 5 th place), which might indicate that it is not the optimal treatment option for both patient groups most of the time. If we are to further inspect each inotrope's individual properties, some important distinctions can be drawn between the alternatives. First of all, adrenaline was graded as having high isotropy, which is crucial, a very high vasopressor effect, and a very low vasodilator effect on peripheral vasculature. On the other hand, however, it has a very high tachycardia causation rate, which in turn lends itself to a highly increased myocardial oxygen demand, very great peripheral organ damage, and, most importantly, a very high-grad and possibly quite problematic side effect list which includes pulmonary congestion, lactic acidosis, myocardial ischemia, thermogenesis, and intracranial bleeding. Therefore, some of its most distinct properties suggest it is a beneficial immediate intervention drug, albeit with comparatively significant risks. Secondly, we can see that noradrenaline has a very similar profile of properties to adrenaline. Both share the same parameter grade for vasodilator and vasopressor effects; noradrenaline has lower isotropy, tachycardia causation, a relatively more preferable side effects list, and much lower chronotropic effect. These properties seem to suggest that noradrenaline is still an immediate intervention drug. Still, it is slightly less aggressive in its benefits and, relative to adrenaline, it has noticeably better proportionate risk factors. The third inotrope alternative, dopamine, has a higher vasodilator effect, similar vasopressor effect, and yet it still has as good isotropy as adrenaline. With a much lower increase in myocardial oxygen demand, although it still causes high-grade tachycardia rates, it presents a very important distinction: it has a much better diuresis rate, which is highly desirable. Dopamine has much more tolerable side effects, yet it has some unique side effects that may result in congestion and should not be disregarded. Dobutamine has the same dopamine property grades, with a vasodilator effect andotropy. Yet, it has a lower vasopressor effect (graded at medium), a significantly lower chronotropic effect, lower tachycardia rates (graded at medium) and, identically to dopamine, much lower peripheral organ damage rates than adrenaline or noradrenaline when used in longer terms. However, it has significantly increased myocardial oxygen demand, the highest amongst all the alternatives, and an almost non-existent diuresis effect. All these factors considered, dobutamine seems to be a drug that should be carefully considered according to a specific patient and their clinical presentation. Finally, milrinone has some unique properties to consider. Since it has a different effect mechanism, only milrinone can be used with beta blockers, and it has a much longer effective half-life than the other inotropes.