A Standardized and Regionalized Network of Care for Cardiogenic Shock

Tehrani, Behnam; Sherwood, Matthew W.; Rosner, Carolyn; Truesdell, Alexander G.; Lee, Seiyon Ben; Damluji, Abdulla; Desai, Mehul; Desai, Shashank; Epps, Kelly; Flanagan, M. Casey; Howard, Edward; Ibrahim, Nasrien E.; Kennedy, Jamie L.W.; Moukhachen, Hala; Psotka, Mitchell A.; Raja, Anika; Saeed, Ibrahim M.; Shah, Palak; Singh, Ramesh; Sinha, Shashank S.; Tang, Daniel; Welch, Timothy; Young, Karl D; deFilippi, Christopher R.; Speir, Alan M.; O’Connor, Christopher M.; Batchelor, Wayne

doi:10.1016/j.jchf.2022.04.004

Cited by 34 publications

(26 citation statements)

References 38 publications

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“…The overall decreasing trend in CS mortality may be attributable to increasing awareness among providers about the importance of early recognition of CS, prompt revascularization in patients with AMI-CS, team-based care, and early MCS utilization. 7,8,33 Unfortunately, due to the dataset's limitations, we could not explore the reasons for the uptrend in mortality among the young age group (20-44 years). The 20-44-year age group has several distinct characteristics that could explain these findings.…”

Section: Discussionmentioning

confidence: 99%

Age stratified sex‐related differences in incidence, management, and outcomes of cardiogenic shock

Osman

Syed

Kheiri

et al. 2022

Cathet Cardio Intervent

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Background There is a lack of data on age‐stratified sex differences in the incidence, treatment, and outcomes of cardiogenic shock (CS). We sought to study these differences from a contemporary database. Methods Patients admitted with CS (2004–2018) were identified from the United States National Inpatient Sample. We compared CS (acute myocardial infarction‐related cardiogenic shock [AMI‐CS] and non‐acute myocardial infarction‐related cardiogenic shock [Non‐AMI‐CS]) incidence, management, and outcomes in males and females, stratified into four age groups (20–44, 45–64, 65–84, and ≥85 years of age). Propensity score matching (PSM) was used for adjustment. Results A total of 1,506,281 weighted hospitalizations for CS were included (AMI‐CS, 39%; Non‐AMI‐CS, 61%). Across all age groups, females had a lower incidence of CS compared with males. After PSM and among the AMI‐CS cohort, higher mortality among females compared with males was observed in the age groups 45–64 (28.5% vs. 26.3%) and 65–84 years (39.3% vs. 37.9%) (p < 0.01, for all). Among the Non‐AMI‐CS cohort, higher mortality among females compared with males was observed in the age groups 20–44 (33.5% vs. 30.5%), 45–64 (35.1% vs. 31.9%), and 65–84 years (41.7% vs. 40.3%) (p < 0.01, for all). Similar age‐dependent differences in the management of CS were also observed between females and males. Conclusions Females have a lower incidence of CS regardless of age. Significant disparities in the management and outcomes of CS were observed based on sex. However, these disparities varied by age and etiology of CS (AMI‐CS vs. Non‐AMI‐CS) with pronounced disparity among females in the age range of 45–84 years.

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Section: Discussionmentioning

confidence: 99%

Age stratified sex‐related differences in incidence, management, and outcomes of cardiogenic shock

Osman

Syed

Kheiri

et al. 2022

Cathet Cardio Intervent

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“…As demonstrated in several preclinical models, un upstream left ventricular unloading may activate intracellular pathways protecting mitochondrial function from such reperfusion damage. 28,29 Moreover, detrimental effects of catecholamines on myocardial oxygen consumption and electrical stability are well recognized, 30 so an upstream IMLVAD strategy may favor survival and promote an early vasopressor drug de-escalation.…”

Section: Discussionmentioning

confidence: 99%

Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta‐analysis

Archilletti

Giuliani

Dangas

et al. 2022

Cathet Cardio Intervent

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Objectives: We aim to define whether the timing of microaxial left ventricular assist device (IMLVAD) implantation might impact on mortality in acute myocardial infarction (AMI) cardiogenic shock (CS) patients who underwent primary percutaneous coronary intervention (PPCI).Background: Despite the widespread use of PPCI, mortality in patients with AMI and CS remains high. Mechanical circulatory support is a promising bridge to recovery strategy, but evidence on its benefit is still inconclusive and the optimal timing of its utilization remains poorly explored. Methods:We compared clinical outcomes of upstream IMLVAD use before PPCI versus bailout use after PPCI in patients with AMI CS. A systematic review and meta-analysis of studies comparing the two strategies were performed. Effect size was reported as odds ratio (OR) using bailout as reference group and a random effect model was used. Study-level risk estimates were pooled through the generic inverse variance method (random effect model).Results: A total of 11 observational studies were identified, including a pooled population of 6759 AMI-CS patients. Compared with a bailout approach, upstream IMLVAD was associated with significant reduction of 30-day

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“…The utility of surrogate marker identification extends beyond risk prediction into the sphere of clinical decision-making. A number of algorithms for CS management incorporate clinical staging and surrogate markers to guide level of care, including appropriateness for ICU placement, invasive hemodynamic monitoring, and MCS initiation [1,4,43]. As above, increased understanding of factors influencing CS outcomes amongst more granular phenotypic cohorts may facilitate more complex, individualized decision-making algorithms that incorporate etiology, specific hemodynamic patterns, and associated inflammatory, metabolic, and organ-related disturbances.…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic strategies for managing patients with cardiogenic shock (CS) have evolved considerably over the past two decades. Today, early revascularization, invasive hemodynamic profiling, and initiation of temporary mechanical circulatory support (MCS) are routine components of CS management; yet, these represent only a fraction of the clinical decisions that physicians are faced with in caring for patients with CS [1][2][3]. To simplify clinical decisionmaking and reduce the variability in CS management across centers, clinical guidelines and CS management algorithms have relied heavily on clinical, hemodynamic, and biochemical surrogate endpoints to drive treatment recommendations [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Outcomes in cardiogenic shock: the role of surrogate endpoints

Kosyakovsky

Marbach

Nguyen

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewEarly revascularization, invasive hemodynamic profiling, and initiation of temporary mechanical circulatory support (MCS) have all become routine components of cardiogenic shock (CS) management. Despite this evolution in clinical practice, patient selection and timing of treatment initiation remain a significant barrier to achieving sustained improvement in CS outcomes. Recent efforts to standardize CS management, through the development of treatment algorithms, have relied heavily on surrogate endpoints to drive therapeutic decisions. The present review aims to provide an overview of the basis of evidence for those surrogate endpoints commonly employed in clinical trials and CS management algorithms.Recent findingsRecent publications from both observational and randomized cohorts have demonstrated the utility of surrogate endpoints in risk stratifying patients with CS. In particular, invasive hemodynamics using pulmonary artery catheters to guide initiation and weaning of MCS, biochemical markers that portend imminent end-organ failure, and clinical risk scores that combine multiple hemodynamic and laboratory parameters have demonstrated an ability to prognosticate outcomes in patients with CS.SummaryAlthough further validation is necessary, multiple clinical, hemodynamic, and biochemical markers have demonstrated utility as surrogate endpoints in CS, and will undoubtedly assist physicians in clinical decision-making.

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A Standardized and Regionalized Network of Care for Cardiogenic Shock

Cited by 34 publications

References 38 publications

Age stratified sex‐related differences in incidence, management, and outcomes of cardiogenic shock

Age stratified sex‐related differences in incidence, management, and outcomes of cardiogenic shock

Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta‐analysis

Outcomes in cardiogenic shock: the role of surrogate endpoints

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