Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology

Ovidiu Chioncel*, John Parissis, Alexandre Mebazaa, Holger Thiele, Steffen Desch, Johann Bauersachs, Veli Pekka Harjola, Elena Laura Antohi, Mattia Arrigo, Tuvia B. Gal, Jelena Celutkiene, Sean P. Collins, Daniel DeBacker, Vlad A. Iliescu, Ewa Jankowska, Tiny Jaarsma, Kalliopi Keramida, Mitja Lainscak, Lars H. Lund, Alexander R. LyonJosep Masip, Marco Metra, Oscar Miro, Andrea Mortara, Christian Mueller, Wilfried Mullens, Maria Nikolaou, Massimo Piepoli, Susana Price, Giuseppe Rosano, Antoine Vieillard-Baron, Jean M. Weinstein, Stefan D. Anker, Gerasimos Filippatos, Frank Ruschitzka, Andrew J.S. Coats, Petar Seferovic

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patient's underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management.

Original languageEnglish
Pages (from-to)1315-1341
Number of pages27
JournalEuropean Journal of Heart Failure
Volume22
Issue number8
DOIs
StatePublished - 1 Aug 2020

Funding

FundersFunder number
AstraZeneca
Novartis
Sanofi
Boehringer Ingelheim
Boston Scientific Corporation
Universität Zürich
Vifor Pharma
Servier

    Keywords

    • Cardiogenic shock
    • Mechanical circulatory support
    • Multidisciplinary team
    • Organ dysfunction

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