With survival rates after cardiogenic shock (CS) increasing, a JACC State-of-the-Art Review outlines a multidisciplinary, longitudinal approach to CS care aimed at "providing a clinically actionable structure for care pathways, resource planning and future research."

Vanessa Blumer, MD, FACC; Shashank S. Sinha, MD, FACC; et al., introduce a "Cardiogenic Shock Survivorship Continuum" that outlines three interdisciplinary phases of CS care. The first phase of acute rescue and stabilization focuses on early recognition, hemodynamic support and end-organ rescue. In-hospital optimization and trajectory assessment make up the second phase, providing an "actionable window" for targeted diagnostics, initiation of guideline-directed medical therapy and weaning of temporary mechanical circulatory support. The third phase involving post-shock discharge care aims to minimize rehospitalizations, address physical and psychosocial effects, and advance medical therapy.

"This framework emphasizes the multisystem nature of cardiogenic shock survivorship, integrating cardiac and noncardiac organ function, functional status, cognition, psychosocial health and evolving trajectory risk over time," write Blumer and colleagues, noting that the constructs are not mutually exclusive and that overlap is expected.

In addition to the continuum, the review stresses the importance of standardized in-hospital protocols, risk-stratification strategies and multidisciplinary outpatient models to help inform medical therapy, rehabilitation and psychosocial support.

"Redefining therapeutic success in CS must extend beyond short-term hemodynamic stabilization to include long-term functional recovery," state the authors. They add that future efforts should include public-private partnerships to help with generating long-term data looking at device performance, complications and functional recovery. Prioritizing patient and caregiver voices in trial design and outcome selection will also be important for ensuring "alignment with real-world priorities" and strengthening "the translational impact of research."