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Published on: June 12, 2021
Risk Prediction in Cardiogenic Shock: Current State of Knowledge, Challenges and Opportunities
Sanjog Kalra1, Lauren S Ranard2, Sehrish Memon3
1The Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Insights
Cardiogenic shock (CS) prognostication is challenging due to its complexity. New risk scores are needed to better predict outcomes and guide treatment, incorporating modern therapies and hemodynamic data.
Area of Science:
- Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) presents a significant mortality risk with uncertain prognostication.
- Existing risk scores for CS are often complex and do not integrate contemporary hemodynamic parameters or advanced therapies.
Purpose of the Study:
- To review current cardiogenic shock risk scores.
- To analyze variables most predictive of CS outcomes.
- To propose a framework for developing novel, dynamic risk-prediction models for CS.
Main Methods:
- Review and analysis of existing cardiogenic shock risk stratification tools.
- Examination of key variables influencing CS patient outcomes.
- Exploration of frameworks for new risk score development.
Main Results:
- Current CS risk scores have limitations in clinical application and fail to incorporate modern treatment modalities.
- Specific hemodynamic parameters and contemporary interventions significantly impact CS outcomes.
- A need exists for more adaptable and comprehensive risk-prediction models.
Conclusions:
- There is a critical need for improved risk-prediction models in cardiogenic shock.
- Novel models should integrate dynamic hemodynamic data and emerging therapies for accurate prognostication.
- Better risk stratification will aid in optimizing patient management and treatment decisions.
Abstract:
Cardiogenic shock (CS) is a condition associated with high mortality rates in which prognostication is uncertain for a variety of reasons, including its myriad causes, its rapidly evolving clinical course and the plethora of established and emerging therapies for the condition. A number of validated risk scores are available for CS prognostication; however, many of these are tedious to use, are designed for application in a variety of populations and fail to incorporate contemporary hemodynamic parameters and contemporary mechanical circulatory support interventions that can affect outcomes. It is important to separate patients with CS who may recover with conservative pharmacological therapies from those in who may require advanced therapies to survive; it is equally important to identify quickly those who will succumb despite any therapy. An ideal risk-prediction model would balance incorporation of key hemodynamic parameters while still allowing dynamic use in multiple scenarios, from aiding with early decision making to device weaning. Herein, we discuss currently available CS risk scores, perform a detailed analysis of the variables in each of these scores that are most predictive of CS outcomes and explore a framework for the development of novel risk scores that consider emerging therapies and paradigms for this challenging clinical entity.
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