Heart failure related cardiogenic shock: An ISHLT consensus conference content summary.

In recent years, there have been significant advancements in the understanding, risk-stratification, and treatment of cardiogenic shock (CS). Despite improved pharmacologic and device-based therapies for CS, short-term mortality remains as high as 50%. Most recent efforts in research have focused on CS related to acute myocardial infarction, even though heart failure related CS (HF-CS) accounts for >50% of CS cases. There is a paucity of high-quality evidence to support standardized clinical practices in approach to HF-CS. In addition, there is an unmet need to identify disease-specific diagnostic and risk-stratification strategies upon admission, which might ultimately guide the choice of therapies, and thereby improve outcomes and optimize resource allocation. The heterogeneity in defining CS, patient phenotypes, treatment goals and therapies has resulted in difficulty comparing published reports and standardized treatment algorithms. An International Society for Heart and Lung Transplantation (ISHLT) consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals), with vast clinical and published experience in CS, representing 42 centers worldwide. State-of-the-art HF-CS presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues, including but not limited to models of CS care delivery, patient presentations in HF-CS, and strategies in HF-CS management. This consensus report summarizes the contemporary literature review on HF-CS presented in the first half of the conference (part 1), while the accompanying document (part 2) covers the breakout sessions where the previously agreed upon clinical issues were discussed with an aim to get to a consensus.

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Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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Disclosure statement David Baran reports past honoraria from Abiomed, Livanova, Getinge, Abbott and Teleflex. Current steering committee for CareDx and Natera, data safety monitoring board for XVIVO and the PACCS trial. Manreet Kanwar reports consulting fee from Abbott, Abiomed and CareDx. On Advisory board for Abbott, Abiomed and CorWave. She is on Steering Committee for RECOVER IV, PACCS trial and Cardiogenic Shock Working Group. Filio Billia reports grant funding from Abbott and that she is the chair of the ISHLT MCS Interdisciplinary Network. Dr. Garan, Sinha and Hernandez-Montfort are on the Steering Committee for Cardiogenic Shock Working Group. Jaime Hernandez-Montfort also reports consulting fees/honoraria paid to him from Abiomed and Abbott. Jennifer Cowger reports grants paid to her institution from Abbott, Medtronic and Procyrion. She reports consulting fees from Abbott, Medtronic, BioVentrix and Procyrion paid to her, and honoraria paid to her from Abbott, Zoll and BioVentrix. Meeting travel support from Abbott. She is on the Steering committee for Nuwellis and Endotronix, DSMB for Berlin Heart and BiVACOR, and advisory boards for Abbott, BioCentrix, and CorWave. She is a Deputy Editor for JHLT and Associate Editor for JACC. Dr. Proudfoot reports consulting fees paid to his institution from Becton Dickinson. Dr. Hoong Sern Lim reports payments to his institution for educational courses, and support for educational meeting travel from Abbott. Drs. Blumer, Barnett, Chih, Ensminger, Randhawa, Jennings, Renedo, Vorovich and Hanff report no COI.