2026-04-13T02:09:25Zhttps://recercat.cat/oai/request

oai:recercat.cat:2072/4779942025-11-07T12:41:42Zcom_2072_98col_2072_378192

urn:hdl:2072/477994 The management of heart failure cardiogenic shock : an international RAND appropriateness panel Williams, Stefan Kalakoutas, Antonis Olusanya, Segun Schrage, Benedict Tavazzi, Guido Carnicelli, Anthony P. Montero, Santiago Vandenbriele, Christophe Luk, Adriana Lim, Hoong Sern Bhagra, Sai Kiran Ott, Sascha Farrero, Marta Samsky, Marc D. Kennedy, Jamie L.W. Sen, Sounok Agrawal, Richa Rampersad, Penelope Coniglio, Amanda Pappalardo, Federico Barnett, Christopher Proudfoot, Alastair G. S.O. reports speakers fees from Vygon, Medtronic, Sonosite, and GE healthcare. S.C.O. reports receipt of institutional research and study funds from Novartis Pharma GmbH, as well as institutional research, study and educational grants, speaker fees, advisory board fees and travel cost reimbursement from Abiomed. M.F. reports receipt of a travel grant from Abbott, speaking fees and collaborations from Novartis, Boehringer, Astra-Zeneca, Bayer, Orion Pharma, Vifor. The other authors report no conflicts. A.G.P. is funded by a Medical Research Council CARP Award [MR/W03011X/1] and the Barts Charity. Background: Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. Methods: A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1-3 as inappropriate, 4-6 as uncertain and as 7-9 appropriate). Results: Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. Conclusion: This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines. (Figure presented.) 2024 Article Critical care ; Vol. 28 Núm. 1 (december 2024), p. 105 open access Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. https://creativecommons.org/licenses/by/4.0/