Sean van Diepen1,2,3, Holger Thiele4. 1. Department of Critical Care. 2. Division of Cardiology, Department of Medicine. 3. Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada. 4. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
Abstract
PURPOSE OF REVIEW: In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. RECENT FINDINGS: The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies. There is little evidence supporting the use of temporary mechanical circulatory support or pulmonary arterial catherization in cardiogenic shock, and international guidelines provide weak and conflicting recommendations, yet studies show mechanical circulatory support use is rising exponentially while pulmonary arterial catherization use remains low. Guidelines provide conflicting information on the optimal first-line vasoactive agent and norepinephrine remains the most widely used agent. SUMMARY: There are some inconsistencies between individual guideline recommendations, but there are no consistent associations between the strength of underlying evidence, weight of guideline recommendations, and adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a strong evidence base, together with research efforts to address priority cardiogenic shock research needs, could serve-to-harmonize recommendations and improve patient outcomes.
PURPOSE OF REVIEW: In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. RECENT FINDINGS: The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies. There is little evidence supporting the use of temporary mechanical circulatory support or pulmonary arterial catherization in cardiogenic shock, and international guidelines provide weak and conflicting recommendations, yet studies show mechanical circulatory support use is rising exponentially while pulmonary arterial catherization use remains low. Guidelines provide conflicting information on the optimal first-line vasoactive agent and norepinephrine remains the most widely used agent. SUMMARY: There are some inconsistencies between individual guideline recommendations, but there are no consistent associations between the strength of underlying evidence, weight of guideline recommendations, and adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a strong evidence base, together with research efforts to address priority cardiogenic shock research needs, could serve-to-harmonize recommendations and improve patient outcomes.
Authors: Rasha Kaddoura; Amr Elmoheen; Ehab Badawy; Mahmoud F Eltawagny; Mohamed A Seif; Khalid Bashir; Amar M Salam Journal: J Drug Assess Date: 2021-07-20