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Title: | Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology | Authors: | Chioncel, Ovidiu Parissis, John Mebazaa, Alexandre Thiele, Holger Desch, Steffen Bauersachs, Johann Harjola, Veli-Pekka Antohi, Elena-Laura Arrigo, Mattia Gal, Tuvia B. Celutkiene, Jelena Collins, Sean P. DeBacker , Daniel Iliescu, Vlad A. Jankowska, Ewa Jaarsma, Tiny Keramida, Kalliopi Lainscak, Mitja Lund, Lars H. Lyon, Alexander R. Masip, Josep Metra, Marco Miro, Oscar Mortara, Andrea Mueller, Christian MULLENS, Wilfried Nikolaou, Maria Piepoli, Massimo Price, Susana Rosano, Giuseppe Vieillard-Baron, Antoine Weinstein, Jean M. Anker, Stefan D. Filippatos, Gerasimos Ruschitzka, Frank Coats, Andrew J. S. Seferovic, Petar |
Issue Date: | 2020 | Publisher: | WILEY | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 22 (8) , p. 1315 -1341 | 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. | Notes: | Chioncel, O (corresponding author), Univ Med & Pharm Carol Davila, Inst Emergency Cardiovasc Dis Prof CC Iliescu, Bucharest 950474, Romania. ochioncel@yahoo.co.uk |
Other: | Chioncel, O (corresponding author), Univ Med & Pharm Carol Davila, Inst Emergency Cardiovasc Dis Prof CC Iliescu, Bucharest 950474, Romania. ochioncel@yahoo.co.uk | Keywords: | Cardiogenic shock;Organ dysfunction;Mechanical circulatory support;Multidisciplinary team | Document URI: | http://hdl.handle.net/1942/31970 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.1922 | ISI #: | WOS:000548712000001 | Rights: | © 2020 European Society of Cardiology. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2021 |
Appears in Collections: | Research publications |
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ejhf.1922.pdf | Published version | 3.69 MB | Adobe PDF | View/Open |
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