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

  • Chioncel O Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.
  • Parissis J Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece.
  • Mebazaa A University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France.
  • Thiele H Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
  • Desch S Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
  • Bauersachs J Department of Cardiology & Angiology, Hannover Medical School, Hannover, Germany.
  • Harjola VP Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Antohi EL Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.
  • Arrigo M Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
  • Gal TB Department of Cardiology, Rabin Medical Center, Petah Tiqwa, Israel.
  • Celutkiene J Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
  • Collins SP Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
  • DeBacker D Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium.
  • Iliescu VA Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.
  • Jankowska E Department of Heart Disease, Wroclaw Medical University, University Hospital, Center for Heart Disease, Wroclaw, Poland.
  • Jaarsma T Department of Health, Medicine and Health Sciences, Linköping University, Linköping, Sweden.
  • Keramida K National Kapodistrian University of Athens Medical School, Athens, Greece.
  • Lainscak M Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.
  • Lund LH Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
  • Lyon AR Imperial College London National Heart & Lung Institute, London, UK.
  • Masip J Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
  • Metra M Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Miro O Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi iSunyer (IDIBAPS), Barcelona, Spain.
  • Mortara A Department of Cardiology, Policlinico di Monza, Monza, Italy.
  • Mueller C Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
  • Mullens W Department of Cardiology, Ziekenhuis Oost, Genk, Belgium.
  • Nikolaou M Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece.
  • Piepoli M Heart Failure Unit, Cardiology, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, University of Parma; Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.
  • Price S Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.
  • Rosano G St Georges Hospital NHS Trust University of London, Cardiology Clinical Academy Group, London, UK.
  • Vieillard-Baron A INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France.
  • Weinstein JM Cardiology Department, Soroka University Medical Centre, Beer Sheva, Israel.
  • Anker SD Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.
  • Filippatos G University of Athens, Heart Failure Unit, Attikon University Hospital, Athens, Greece.
  • Ruschitzka F Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
  • Coats AJS Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy.
  • Seferovic P Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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  • 2020-05-30
Published in:
  • European journal of heart failure. - 2020
Cardiogenic shock
Mechanical circulatory support
Multidisciplinary team
Organ dysfunction
English 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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  • English
Open access status
bronze
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https://sonar.ch/global/documents/215401
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