Advances in the Staging and Phenotyping of Cardiogenic Shock

Jentzer, Jacob C.; Rayfield, Corbin; Soussi, Sabri; Berg, David D.; Kennedy, Jason; Sinha, Shashank S.; Baran, David A.; Brant, Emily; Mebazaa, Alexandre; Billia, Filio; Kapur, Navin K.; Henry, Timothy D.; Lawler, Patrick R.

doi:10.1016/j.jacadv.2022.100120

Cited by 31 publications

(42 citation statements)

References 80 publications

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“…It has been suggested that the three-axis observation system can be used as an assessment modality, further improving the accuracy of the SCAI score. This is due to its broader assessment criteria, spanning the examination of shock severity, the clinical phenotype and risk modifiers of both the RV and LV [ 91 , 92 , 93 , 94 ]. Nonetheless, neither’s efficacy has been documented among patients with RVF-related CS.…”

Section: Prognosismentioning

confidence: 99%

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Copeland

Fardman

Furer

2023

Life

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Cardiogenic shock (CS) remains a highly lethal condition despite many efforts and new interventions. Patients presenting with a rapid onset of hemodynamic instability and subsequent collapse require prompt and appropriate multimodality treatment. Multiple etiologies can lead to heart failure and subsequent shock. As the case prevalence of heart failure increases worldwide, it is of great importance to explore all manners and protocols of presentation and treatment present. With research primarily focusing on CS due to cardiac left-sided pathology, few assessments of right-sided pathology and the subsequent clinical state and treatment have been conducted. This review aims to present an in-depth assessment of the currently available literature, assessing the pathophysiology, presentation and management of CS patients due to right heart failure.

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Section: Prognosismentioning

confidence: 99%

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Copeland

Fardman

Furer

2023

Life

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“…Most importantly, there remains an important distinction between the severity of CS and mortality risk itself [22 ▪ ,23]. Although it is a truism that more severe CS will have a worse prognosis, there are numerous crucial risk factors for mortality that extend beyond shock severity alone [21 ▪▪ ,23,38].…”

Section: Individual Markers Of Severity In Cardiogenic Shockmentioning

confidence: 99%

“…Although it is a truism that more severe CS will have a worse prognosis, there are numerous crucial risk factors for mortality that extend beyond shock severity alone [21 ▪▪ ,23,38]. Examples of nonmodifiable risk factors for mortality that are independent from shock severity itself include age and the presence of cardiac arrest with coma and anoxic brain injury [21 ▪▪ ,22 ▪ ,28,47–49]. These “risk modifiers” portend higher mortality risk for patients at any level of shock severity.…”

Section: Individual Markers Of Severity In Cardiogenic Shockmentioning

confidence: 99%

“…Accordingly, two patients with equivalent shock severity by the above criteria could have a markedly different prognosis if, for example, one was substantially older and comatose after a cardiac arrest. Numerous other risk modifiers have been identified and validated for prognostication in CS populations, several of which overlap partially with shock severity or hemodynamics [21 ▪▪ ,22 ▪ ].…”

Section: Individual Markers Of Severity In Cardiogenic Shockmentioning

confidence: 99%

“…Various markers have been established for gauging the severity of shock and subsequently validated in patients with CS [21 ▪▪ ,22 ▪ ,23]. One of the simplest and widely utilized approaches is the quantification of vasopressor requirements.…”

Section: Individual Markers Of Severity In Cardiogenic Shockmentioning

confidence: 99%

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The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment

Jentzer

Baran

2023

Current Opinion in Critical Care

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Purpose of review Cardiogenic shock (CS) has been recognized for >50 years, most commonly in the setting of myocardial infarction. This review covers recent advances in the definitions, epidemiology and severity assessment of cardiogenic shock. Recent findings In this review, the authors discuss the evolving definitions of cardiogenic shock, detailing the early approaches as well as more contemporary ideas. The epidemiology of CS is reviewed and then granular detail on the assessment of shock severity is provided including the role of lactate measurement and invasive hemodynamic assessment. The development of the Society for Cardiac Angiography and Intervention (SCAI) consensus statement on Classification of Cardiogenic Shock is reviewed by the principal authors. The revised SCAI Shock document is reviewed as well and the future directions for assessment of shock along with clinical applications are reviewed. Summary Cardiogenic shock mortality has not changed in a significant way in many years. Recent advances such as more granular assessment of shock severity have the potential to improve outcomes by allowing research to separate the patient groups which may respond differently to various therapies.

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In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

Ergui,

Salama,

Hooda

et al. 2024

Clinical Cardiology

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BackgroundUnhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in‐hospital outcomes and resource utilization in the setting of cardiogenic shock (CS).HypothesisUnhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients.MethodsThe National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD‐9 and ICD‐10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in‐hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05).ResultsWe identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints.ConclusionsThese data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under‐diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long‐term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

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Advances in the Staging and Phenotyping of Cardiogenic Shock

Cited by 31 publications

References 80 publications

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment

In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

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