Management of Heart Failure–Related Cardiogenic Shock

Narang, Nikhil; Blumer, Vanessa; Jumean, Marwan; Kar, Biswajit; Kumbhani, Dharam J.; Bozkurt, Biykem; Uriel, Nir; Guglin, Maya; Kapur, Navin K.

doi:10.1016/j.jchf.2023.04.010

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…V-A ECMO as a primary support modality in the context of SCAI C HF-CS was not discussed as both European and North American guidance propose that it should be broadly reserved for severe shock states i.e. SCAI D and E [ 36 , 37 ]. Nonetheless, observational data suggest V-A ECMO continues to be deployed across all severities of CS and patients with HF-CS may be more vulnerable to the associated complications of increased afterload with V-A ECMO due to higher filling pressures at baseline and potential preload reserve exhaustion [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

Williams,

Kalakoutas,

Olusanya

et al. 2024

Crit Care

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Background Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. Methods A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate). Results Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. Conclusion This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.

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Section: Discussionmentioning

confidence: 99%

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

Williams,

Kalakoutas,

Olusanya

et al. 2024

Crit Care

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“…Early CS patients (SCAI C and, particularly, SCAI B with ‘pre-shock’ phenotype patients) are at high risk of worsening clinical status and progression towards advanced SCAI classes due to the underestimation of haemodynamic impairment. 18 Inotropes still play a role as first-line therapy in these early CS profiles, but their use should be limited to the lowest dose and shortest time interval to avoid end-organ impacts. In these scenarios, up-front pulmonary artery catheter (PAC) placement for accurate risk stratification is strongly recommended.…”

Section: Practical Management Of Inotropes In Cardiogenic Shockmentioning

confidence: 99%

From medical therapy to mechanical support: strategies for device selection and implantation techniques

Bertoldi,

Montisci,

Westermann

et al. 2023

European Heart Journal Supplements

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Cardiogenic shock (CS) is a complex clinical syndrome with a high risk of mortality. The recent, rapid development of temporary mechanical circulatory support (tMCS) has altered CS treatment. While catecholamines remain the cornerstone of CS therapy, tMCS usage has increased. According to shock severity, different treatment strategies including catecholamines alone, catecholamines and tMCS, or multiple tMCS might be used. State-of-the-art implantation techniques are necessary to avoid complications linked to the invasive nature of tMCS. In particular, bleeding and access-site complications might counteract the potential haemodynamic benefit of a percutaneous ventricular assist device. In this review, we describe the role of catecholamines in CS treatment and present the different tMCS devices with an explanation on how to use them according to CS aetiology and severity. Finally, an overview of the best practice for device implantation is provided.

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“…The management of HF-CS is complicated by the heterogeneity of underlying pathologies. The lack of clinical trials and recommendations in the current guidelines further exacerbates the clinical uncertainty in the treatment of HF-CS, particularly with regard to the extent of differences in clinical presentation and response to treatment modalities within this heterogeneous population of shock patients [ 11 , 14 , 15 ]. Moreover, there is a scarcity of data regarding sex-related differences in patients presenting with CS, particularly with HF-CS.…”

Section: Introductionmentioning

confidence: 99%

Sex-related differences in patients presenting with heart failure–related cardiogenic shock

Sundermeyer,

Kellner,

Beer

et al. 2024

Clin Res Cardiol

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Background Heart failure–related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS. Methods In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS. Results N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75–1.19). Conclusions In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS. Graphical abstract Sex-related differences in clinical characteristics, shock severity, and mortality in patients with heart failure–related cardiogenic shock. Summary for the main study findings. AMI, acute myocardial infarction; CI, confidence interval; HF-CS, heart failure–related cardiogenic shock; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; SCAI, Society for Cardiovascular Angiography & Interventions.

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Management of Heart Failure–Related Cardiogenic Shock

Cited by 7 publications

References 13 publications

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

The management of heart failure cardiogenic shock: an international RAND appropriateness panel

From medical therapy to mechanical support: strategies for device selection and implantation techniques

Sex-related differences in patients presenting with heart failure–related cardiogenic shock

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