Cardiogenic Shock; Health Disparities; Equity; Mechanical Circulatory Support; Sex Differences; Multidisciplinary...

This review examines why substantial disparities persist in the management of cardiogenic shock (CS) despite advances in therapy and the existence of clinical guidelines. We synthesize structural, clinical, and ethical mechanisms that shape access to timely and advanced care and highlight equity-oriented solutions.

Across contemporary cohorts, women, older adults, racial/ethnic minorities, and socioeconomically disadvantaged patients remain less likely to receive early coronary angiography, revascularization, or mechanical circulatory support (MCS) and experience longer inter-hospital transfer delays. Reported gaps typically range from ~ 20-40% lower use of guideline-recommended therapies compared with reference groups, independent of comorbidity and presentation severity. Drivers include implicit bias, variable institutional resources, uneven protocol activation, and discretionary triage under time pressure.  Equity in CS care cannot be achieved by protocols alone. It requires deliberate measurement, culturally responsive decision-making, and system-level accountability. Equity-minded implementation of protocolized care, regionalized hub-and-spoke networks, multidisciplinary shock teams, and disparity-sensitive metrics shows promise. Success in CS should be defined not only as survival but also as equitable inclusion in the full spectrum of recognition, triage, escalation, and shared decision-making.