Personalizing care in cardiogenic shock: Searching for a common hemodynamic language

Clinical Outcomes Associated With Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock

“…8–10 Granular real-world data in an all-comer HF-CS population not restricted to a specific clinical outcome would provide important insight into practice patterns, enable identification of hemodynamic and metabolic parameters associated with survival and potentially serve as a framework to evaluate the impact of specific interventions, including inotrope/vasoactive medications, decongestive strategies, mechanical ventilation, and AMCS devices in this poorly studied CS subgroup. 11–13…”

“…[8][9][10] Granular real-world data in an all-comer HF-CS population not restricted to a specific clinical outcome would provide important insight into practice patterns, enable identification of hemodynamic and metabolic parameters associated with survival and potentially serve as a framework to evaluate the impact of specific interventions, including inotrope/vasoactive medications, decongestive strategies, mechanical ventilation, and AMCS devices in this poorly studied CS subgroup. [11][12][13] Given the lack of real-world data for HF-CS, we sought to define clinical, hemodynamic, metabolic, and both drug and device treatment parameters associated with clinical outcomes among patients with HF presenting with CS using data from the Cardiogenic Shock Working Group (CSWG) registry. We hypothesized that, among patients with HF-CS, increased AMCS device utilization was associated with worsening baseline hemodynamic severity, the highest probability of in-hospital mortality, and the lowest likelihood of native heart survival (NHS).…”

Hemodynamic-based Assessment and Management of Cardiogenic Shock

“…19,20 Furthermore, the effect of delaying access to dedicated cardiac intensive care units with a hemodynamicbased approach in CS remains a frontier that affects our interpretation of transitions, disease trajectory, and severity staging while impacting our connection with frontline caregivers. 21,22 Based on the scalable heterogeneity from a cellular level to healthcare systems in hemodynamicbased management of patients experiencing CS, we present considerations towards systematic hemodynamic-based transitions in which distinct clinical entities (AMI-CS, HF-CS, CA-CS, post-cardiotomy shock [PCS], PE-CS, and VHD-CS; Supplementary Material Table 1) share the common path of early identification and rapid transitions through an adaptive longitudinal situational awareness model of care that influences specific management considerations. 23…”