Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach

Alastair G. Proudfoot; Antonis Kalakoutas; Susanna Meade; Mark J.D. Griffiths; Mir Basir; Francesco Burzotta; Sharon Chih; Eddy Fan; Jonathan Haft; Nasrien Ibrahim; Natalie Kruit; Hoong Sern Lim; David A. Morrow; Jun Nakata; Susanna Price; Carolyn Rosner; Robert Roswell; Mark A. Samaan; Marc D. Samsky; Holger Thiele; Alexander G. Truesdell; Sean van Diepen; Michelle Doughty Voeltz; Peter M. Irving

doi:10.1161/CIRCHEARTFAILURE.121.008635

Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach

Alastair G. Proudfoot^*, Antonis Kalakoutas, Susanna Meade, Mark J.D. Griffiths, Mir Basir, Francesco Burzotta, Sharon Chih, Eddy Fan, Jonathan Haft, Nasrien Ibrahim, Natalie Kruit, Hoong Sern Lim, David A. Morrow, Jun Nakata, Susanna Price, Carolyn Rosner, Robert Roswell, Mark A. Samaan, Marc D. Samsky, Holger ThieleAlexander G. Truesdell, Sean van Diepen, Michelle Doughty Voeltz, Peter M. Irving

^*Corresponding author for this work

Peter Gorer Department of Immunobiology

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

BACKGROUND: Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. METHODS: An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. RESULTS: There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. CONCLUSIONS: While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.

Original language	English
Pages (from-to)	1331-1340
Number of pages	10
Journal	Circulation: Heart Failure
Volume	14
Issue number	12
DOIs	https://doi.org/10.1161/CIRCHEARTFAILURE.121.008635
Publication status	Published - 1 Dec 2021

Keywords

Consensus
Hemodynamics
Myocardial infarction
Percutaneous coronary intervention
Shock, cardiogenic

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/CIRCHEARTFAILURE.121.008635

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Proudfoot, A. G., Kalakoutas, A., Meade, S., Griffiths, M. J. D., Basir, M., Burzotta, F., Chih, S., Fan, E., Haft, J., Ibrahim, N., Kruit, N., Lim, H. S., Morrow, D. A., Nakata, J., Price, S., Rosner, C., Roswell, R., Samaan, M. A., Samsky, M. D., ... Irving, P. M. (2021). Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach. Circulation: Heart Failure, 14(12), 1331-1340. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008635

@article{79acaf8dce8c4097bf6c212da6c3fb16,

title = "Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach",

abstract = "BACKGROUND: Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. METHODS: An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. RESULTS: There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. CONCLUSIONS: While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock. ",

keywords = "Consensus, Hemodynamics, Myocardial infarction, Percutaneous coronary intervention, Shock, cardiogenic",

author = "Proudfoot, {Alastair G.} and Antonis Kalakoutas and Susanna Meade and Griffiths, {Mark J.D.} and Mir Basir and Francesco Burzotta and Sharon Chih and Eddy Fan and Jonathan Haft and Nasrien Ibrahim and Natalie Kruit and Lim, {Hoong Sern} and Morrow, {David A.} and Jun Nakata and Susanna Price and Carolyn Rosner and Robert Roswell and Samaan, {Mark A.} and Samsky, {Marc D.} and Holger Thiele and Truesdell, {Alexander G.} and {van Diepen}, Sean and Voeltz, {Michelle Doughty} and Irving, {Peter M.}",

note = "Publisher Copyright: {\textcopyright} 2021 American Heart Association, Inc.",

year = "2021",

month = dec,

day = "1",

doi = "10.1161/CIRCHEARTFAILURE.121.008635",

language = "English",

volume = "14",

pages = "1331--1340",

journal = "Circulation: Heart Failure",

issn = "1941-3289",

publisher = "Lippincott Williams and Wilkins",

number = "12",

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Proudfoot, AG, Kalakoutas, A, Meade, S, Griffiths, MJD, Basir, M, Burzotta, F, Chih, S, Fan, E, Haft, J, Ibrahim, N, Kruit, N, Lim, HS, Morrow, DA, Nakata, J, Price, S, Rosner, C, Roswell, R, Samaan, MA, Samsky, MD, Thiele, H, Truesdell, AG, van Diepen, S, Voeltz, MD & Irving, PM 2021, 'Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach', Circulation: Heart Failure, vol. 14, no. 12, pp. 1331-1340. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008635

TY - JOUR

T1 - Contemporary Management of Cardiogenic Shock

T2 - A RAND Appropriateness Panel Approach

AU - Proudfoot, Alastair G.

AU - Kalakoutas, Antonis

AU - Meade, Susanna

AU - Griffiths, Mark J.D.

AU - Basir, Mir

AU - Burzotta, Francesco

AU - Chih, Sharon

AU - Fan, Eddy

AU - Haft, Jonathan

AU - Ibrahim, Nasrien

AU - Kruit, Natalie

AU - Lim, Hoong Sern

AU - Morrow, David A.

AU - Nakata, Jun

AU - Price, Susanna

AU - Rosner, Carolyn

AU - Roswell, Robert

AU - Samaan, Mark A.

AU - Samsky, Marc D.

AU - Thiele, Holger

AU - Truesdell, Alexander G.

AU - van Diepen, Sean

AU - Voeltz, Michelle Doughty

AU - Irving, Peter M.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - BACKGROUND: Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. METHODS: An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. RESULTS: There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. CONCLUSIONS: While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.

AB - BACKGROUND: Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. METHODS: An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. RESULTS: There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. CONCLUSIONS: While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.

KW - Consensus

KW - Hemodynamics

KW - Myocardial infarction

KW - Percutaneous coronary intervention

KW - Shock, cardiogenic

UR - http://www.scopus.com/inward/record.url?scp=85122290090&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.121.008635

DO - 10.1161/CIRCHEARTFAILURE.121.008635

M3 - Article

C2 - 34807723

AN - SCOPUS:85122290090

SN - 1941-3289

VL - 14

SP - 1331

EP - 1340

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

IS - 12

ER -

Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach

Abstract

Keywords

UN SDGs

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