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      Epidemiology, Pathophysiology and Contemporary Management of Cardiogenic Shock ‐ A position statement from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 6 , 7 , 8 , 9 , 1 , 2 , 10 , 11 , 12 , 13 , 14 , 15 , 1 , 2 , 16 , 17 , 18 , 4 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 3 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 10 , 46 , 47 , 48
      European Journal of Heart Failure
      Wiley

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          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.

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          Author and article information

          Journal
          European Journal of Heart Failure
          Eur J Heart Fail
          Wiley
          1388-9842
          1879-0844
          May 29 2020
          Affiliations
          [1 ]Emergency Institute for Cardiovascular Diseases ‘Prof. C.C.Iliescu' Bucharest Romania
          [2 ]University of Medicine Carol Davila Bucharest Romania
          [3 ]Heart Failure Unit, Department of CardiologyAttikon University Hospital Athens Greece
          [4 ]National Kapodistrian University of Athens Medical School Athens Greece
          [5 ]University of Paris Diderot Hôpitaux Universitaires Saint Louis Lariboisière, APHP Paris France
          [6 ]Department of Internal Medicine/CardiologyHeart Center Leipzig at University of Leipzig Leipzig Germany
          [7 ]Heart Institute Leipzig Germany
          [8 ]Hannover Med Sch, Dept Cardiol & Angiol Hannover Germany
          [9 ]Emergency Medicine, University of HelsinkiHelsinki University Hospital Helsinki Finland
          [10 ]Department of CardiologyUniversity Hospital Zurich Zurich Switzerland
          [11 ]Rabin Med Ctr, Dept Cardiol, Beilinson Campus Petah Tiqwa Israel
          [12 ]Tel Aviv Univ, Sackler Fac Med Tel Aviv Israel
          [13 ]Clinic of Cardiac and Vascular Diseases, Institute of Clinical MedicineMedical Faculty of Vilnius University Vilnius Lithuania
          [14 ]Department of Emergency MedicineVanderbilt University School of Medicine Nashville US
          [15 ]Department of Intensive CareCHIREC Hospitals, Université Libre de Bruxelles Brussels Belgium
          [16 ]Wroclaw Med Univ, Univ Hosp, Ctr Heart Dis, Dept Heart Dis, Wroclaw Poland
          [17 ]Department of Health, Medicine and Health SciencesLinköping University Linköping Sweden
          [18 ]Julius CenterUniversity Medical Center Utrecht the Netherlands
          [19 ]Department of CardiologyAttikon University Hospital Athens Greece
          [20 ]Gen Hosp Murska Sobota, Div Cardiol Murska Sobota Slovenia
          [21 ]Univ Ljubljana, Fac Med Ljubljana Slovenia
          [22 ]Heart and Vascular ThemeKarolinska University Hospital Stockholm Sweden
          [23 ]Department of MedicineKarolinska Institutet Stockholm Sweden
          [24 ]Imperial College London National Heart & Lung Institute London UK
          [25 ]Royal Brompton Hospital London UK
          [26 ]Consorci Sanitari IntegralUniversity of Barcelona Barcelona Spain
          [27 ]Hospital Sanitas CIMA Barcelona Spain
          [28 ]Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
          [29 ]Emergency Department,Hospital ClinicInstitutd' Investigació Biomèdica August Pi iSunyer (IDIBAPS) Spain
          [30 ]University of Barcelona Barcelona Spain
          [31 ]Department of CardiologyPoliclinico di Monza Monza Italy
          [32 ]Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel Basel Switzerland
          [33 ]Department of CardiologyZiekenhuis Oost Genk Belgium
          [34 ]Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
          [35 ]Heart Failure Unit, Cardiology, Emergency Dept., Guglielmo da Saliceto Hospital, PiacenzaUniversity of Parma; Institute of Life Sciences Sant'Anna School of Advanced Studies Pisa Italy
          [36 ]Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London UK Royal Brompton Hospital London UK
          [37 ]St Georges Hosp NHS Trust Univ LondonCardiovasc Clin Acad Grp London England
          [38 ]Department of Medical SciencesCentre for Clinical and Basic Research IRCCS San Raffaele Pisana Rome Italy
          [39 ]INSERM U‐1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807 Villejuif France
          [40 ]University Hospital Ambroise Paré AP‐, HP Boulogne‐Billancourt France
          [41 ]Cardiology DepartmentSoroka University Medical Centre Beer Sheva Israel
          [42 ]Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT)German Centre for Cardiovascular Research (DZHK) partner site Berlin Berlin Germany
          [43 ]Charité Universitätsmedizin Berlin Germany
          [44 ]Univ Athens, Attikon Univ Hosp, Heart Failure Unit Athens Greece
          [45 ]Univ Cyprus, Sch Med Nicosia Cyprus
          [46 ]Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana Rome Italy
          [47 ]Faculty of MedicineUniversity of Belgrade Belgrade Serbia
          [48 ]Serbian Academy of Sciences and Arts Belgrade Serbia
          Article
          10.1002/ejhf.1922
          32469155
          b402f00f-e915-4c2a-b4cd-9c5ce2b25749
          © 2020

          http://onlinelibrary.wiley.com/termsAndConditions#vor

          http://doi.wiley.com/10.1002/tdm_license_1.1


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