1. Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach
- Author
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David A. Morrow, Alastair G. Proudfoot, Natalie Kruit, Robert O. Roswell, Susanna Price, Mir B Basir, Nasrien E. Ibrahim, Francesco Burzotta, Sharon Chih, Sean van Diepen, Eddy Fan, Mark A Samaan, Marc D. Samsky, Michelle Doughty Voeltz, Alexander G. Truesdell, Carolyn Rosner, Antonis Kalakoutas, Susanna Meade, Hoong Sern Lim, Peter M. Irving, Jonathan W. Haft, Holger Thiele, Jun Nakata, and Mark J.D. Griffiths
- Subjects
medicine.medical_specialty ,Consensus ,media_common.quotation_subject ,medicine.medical_treatment ,Shock, Cardiogenic ,shock ,hemodynamics ,Article ,law.invention ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Surveys and Questionnaires ,cardiogenic ,Medicine ,Humans ,Quality (business) ,Myocardial infarction ,Intensive care medicine ,media_common ,Heart Failure ,Clinical Trials as Topic ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,medicine.disease ,myocardial infarction ,Current practice ,Expert opinion ,Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,Professional association ,Cardiology and Cardiovascular Medicine ,business - 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 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.
- Published
- 2021