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Article ; Online: Where we came from and where we are going: a perspective on the practice changing recommendations from the 2022 ESC/ERS pulmonary hypertension guidelines.

Barnett, Christopher F / De Marco, Teresa / Galiè, Nazzareno

European heart journal. Acute cardiovascular care

2023 Volume 12, Issue 1, Page(s) 58–61

MeSH term(s)	Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/therapy ; Algorithms
Language	English
Publishing date	2023-01-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1093/ehjacc/zuac148
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Article ; Online: Management of Cardiogenic Shock Unrelated to Acute Myocardial Infarction.

Barnett, Christopher F / Brusca, Samuel B / Hanff, Thomas C / Blumer, Vanessa / Kalif, Adnan / Kanwar, Manreet

The Canadian journal of cardiology

2023 Volume 39, Issue 4, Page(s) 406–419

Abstract: Cardiogenic shock is an extreme manifestation of acute decompensated heart failure. Cardiogenic shock is often caused by-and has traditionally been studied in the setting of-acute myocardial infarction (AMI CS); however, there is increasing incidence and ...

Abstract	Cardiogenic shock is an extreme manifestation of acute decompensated heart failure. Cardiogenic shock is often caused by-and has traditionally been studied in the setting of-acute myocardial infarction (AMI CS); however, there is increasing incidence and recognition of cardiogenic shock not associated with acute myocardial infarction (non-AMI CS) as a distinct entity. Despite decades of study and technologic advancements, cardiogenic shock mortality remains as high as 50%, regardless of etiology. New approaches to shock phenotyping and classification have emerged, with a focus on appropriately matching patient physiology to a growing list of available interventions. Further study is needed to determine whether these efforts will lead to more nuanced use of mechanical circulatory support and improved patient outcomes, especially in non-AMI CS. In the meantime, models of care incorporating multidisciplinary decision making, such as shock teams, may improve patient selection and outcomes.
MeSH term(s)	Humans ; Shock, Cardiogenic/therapy ; Shock, Cardiogenic/complications ; Myocardial Infarction/complications ; Myocardial Infarction/therapy ; Heart Failure/complications ; Treatment Outcome
Language	English
Publishing date	2023-01-31
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2023.01.023
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Article ; Online: Impella Management for the Cardiac Intensivist.

Papolos, Alexander I / Barnett, Christopher F / Tuli, Aakash / Vavilin, Ilan / Kenigsberg, Benjamin B

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2022 Volume 68, Issue 6, Page(s) 753–758

Abstract: The Impella mechanical circulatory support (MCS) system is a catheter-based continuous flow cardiac assist device that is widely used in the treatment of cardiogenic shock in medical and surgical cardiac intensive care units. As with all forms of MCS, ... ...

Abstract	The Impella mechanical circulatory support (MCS) system is a catheter-based continuous flow cardiac assist device that is widely used in the treatment of cardiogenic shock in medical and surgical cardiac intensive care units. As with all forms of MCS, device-related complications remain a major concern, the incidence of which can be mitigated by adhering to a few fundamental concepts in device management. The purpose of this review is to comprehensively describe our strategy for managing, repositioning, and weaning the Impella catheter.
MeSH term(s)	Catheters/adverse effects ; Heart-Assist Devices/adverse effects ; Humans ; Intensive Care Units ; Retrospective Studies ; Shock, Cardiogenic/surgery ; Treatment Outcome
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000001680
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Article ; Online: Critical care management of the patient with pulmonary hypertension.

Barnett, Christopher F / O'Brien, Connor / De Marco, Teresa

European heart journal. Acute cardiovascular care

2021 Volume 11, Issue 1, Page(s) 77–83

Abstract: Pulmonary hypertension (PH) is a common diagnosis in patients admitted to the cardiac intensive care unit with a wide range of underlying causes. A detailed evaluation to identify all factors contributing to the elevated pulmonary artery pressure and ... ...

Abstract	Pulmonary hypertension (PH) is a common diagnosis in patients admitted to the cardiac intensive care unit with a wide range of underlying causes. A detailed evaluation to identify all factors contributing to the elevated pulmonary artery pressure and provide an assessment of right ventricular haemodynamics and function is needed to guide treatment and identify patients at highest risk for poor outcomes. While in many patients management of underlying and triggering medical problems with careful monitoring is appropriate, a subset of patients may benefit from specialized treatments targeting the pulmonary circulation and support of the right ventricle. In such cases, collaboration with or transfer to a centre with special expertise in the management of PH may be warranted.
MeSH term(s)	Critical Care ; Heart Ventricles ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/therapy ; Intensive Care Units ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/therapy
Language	English
Publishing date	2021-12-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1093/ehjacc/zuab113
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Article ; Online: Cardiogenic Shock in Older Adults: A Focus on Age-Associated Risks and Approach to Management: A Scientific Statement From the American Heart Association.

Blumer, Vanessa / Kanwar, Manreet K / Barnett, Christopher F / Cowger, Jennifer A / Damluji, Abdulla A / Farr, Maryjane / Goodlin, Sarah J / Katz, Jason N / McIlvennan, Colleen K / Sinha, Shashank S / Wang, Tracy Y

Circulation

2024 Volume 149, Issue 14, Page(s) e1051–e1065

Abstract: Cardiogenic shock continues to portend poor outcomes, conferring short-term mortality rates of 30% to 50% despite recent scientific advances. Age is a nonmodifiable risk factor for mortality in patients with cardiogenic shock and is often considered in ... ...

Abstract	Cardiogenic shock continues to portend poor outcomes, conferring short-term mortality rates of 30% to 50% despite recent scientific advances. Age is a nonmodifiable risk factor for mortality in patients with cardiogenic shock and is often considered in the decision-making process for eligibility for various therapies. Older adults have been largely excluded from analyses of therapeutic options in patients with cardiogenic shock. As a result, despite the association of advanced age with worse outcomes, focused strategies in the assessment and management of cardiogenic shock in this high-risk and growing population are lacking. Individual programs oftentimes develop upper age limits for various interventional strategies for their patients, including heart transplantation and durable left ventricular assist devices. However, age as a lone parameter should not be used to guide individual patient management decisions in cardiogenic shock. In the assessment of risk in older adults with cardiogenic shock, a comprehensive, interdisciplinary approach is central to developing best practices. In this American Heart Association scientific statement, we aim to summarize our contemporary understanding of the epidemiology, risk assessment, and in-hospital approach to management of cardiogenic shock, with a unique focus on older adults.
MeSH term(s)	Humans ; Aged ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/epidemiology ; Shock, Cardiogenic/therapy ; American Heart Association ; Treatment Outcome ; Heart-Assist Devices ; Heart Transplantation
Language	English
Publishing date	2024-02-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIR.0000000000001214
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Article ; Online: Training Paradigms in Critical Care Cardiology: A Scoping Review of Current Literature.

Vallabhajosyula, Saraschandra / Mehta, Aryan / Bansal, Mridul / Jentzer, Jacob C / Applefeld, Willard N / Sinha, Shashank S / Geller, Bram J / Gage, Ann E / Rose, Scott W / Barnett, Christopher F / Katz, Jason N / Morrow, David A / Roswell, Robert O / Solomon, Michael A

JACC. Advances

2024 Volume 3, Issue 3

Abstract: Background: Over the past decade there has been increasing interest in critical care medicine (CCM) training for cardiovascular medicine (CV) physicians either in isolation (separate programs in either order [CV/CCM], integrated critical care cardiology ...

Abstract	Background: Over the past decade there has been increasing interest in critical care medicine (CCM) training for cardiovascular medicine (CV) physicians either in isolation (separate programs in either order [CV/CCM], integrated critical care cardiology [CCC] training) or hybrid training with interventional cardiology (IC)/heart failure/transplant (HF) with targeted CCC training. Objective: To review the contemporary landscape of CV/CCM, CCC, and hybrid training. Methods: We reviewed the literature from 2000-2022 for publications discussing training in any combination of internal medicine CV/CCM, CCC, and hybrid training. Information regarding training paradigms, scope of practice and training, duration, sequence, and milestones was collected. Results: Of the 2,236 unique citations, 20 articles were included. A majority were opinion/editorial articles whereas two were surveys. The training pathways were classified into - (i) specialty training in both CV (3 years) and CCM (1-2 years) leading to dual American Board of Internal Medicine (ABIM) board certification, or (ii) base specialty training in CV with competencies in IC, HF or CCC leading to a non-ABIM certificate. Total fellowship duration varied between 4-7 years after a three-year internal medicine residency. While multiple articles commented on the ability to integrate the fellowship training pathways into a holistic and seamless training curriculum, few have highlighted how this may be achieved to meet competencies and standards. Conclusions: In 20 articles describing CV/CCM, CCC, and hybrid training, there remains significant heterogeneity on the standardized training paradigms to meet training competencies and board certifications, highlighting an unmet need to define CCC competencies.
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ISSN	2772-963X
ISSN (online)	2772-963X
DOI	10.1016/j.jacadv.2024.100850
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Article ; Online: Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices.

Senman, Balimkiz / Jentzer, Jacob C / Barnett, Christopher F / Bartos, Jason A / Berg, David D / Chih, Sharon / Drakos, Stavros G / Dudzinski, David M / Elliott, Andrea / Gage, Ann / Horowitz, James M / Miller, P Elliott / Sinha, Shashank S / Tehrani, Behnam N / Yuriditsky, Eugene / Vallabhajosyula, Saraschandra / Katz, Jason N

Journal of the American Heart Association

2024 Volume 13, Issue 6, Page(s) e031979

Abstract: Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular ... ...

Abstract	Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.
MeSH term(s)	Humans ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/therapy ; Shock, Cardiogenic/etiology
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.123.031979
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Article ; Online: The shock team: a multidisciplinary approach to early patient phenotyping and appropriate care escalation in cardiogenic shock.

Brusca, Samuel B / Caughron, Hope / Njoroge, Joyce N / Cheng, Richard / O'Brien, Connor G / Barnett, Christopher F

Current opinion in cardiology

2022 Volume 37, Issue 3, Page(s) 241–249

Abstract: Purpose of review: Cardiogenic shock (CS) is a highly morbid condition with mortality remaining greater than 30% despite improved pathophysiologic understanding and access to mechanical circulatory support (MCS). In response, shock teams modeled on ... ...

Abstract	Purpose of review: Cardiogenic shock (CS) is a highly morbid condition with mortality remaining greater than 30% despite improved pathophysiologic understanding and access to mechanical circulatory support (MCS). In response, shock teams modeled on successful multidisciplinary care structures for other diseases are being implemented nationwide. Recent findings: Primary data supporting a benefit of shock team implementation on patient outcomes are relatively limited and entirely observational. Four single-center before-and-after studies and one multicenter registry study have demonstrated improved outcomes in patients with CS, potentially driven by increased pulmonary artery catheter (PAC) utilization and earlier (and more appropriate) initiation of MCS. Shock teams are also supported by a growing body of literature recognizing the independent benefit of the interventions they seek to implement, including patient phenotyping with PAC use and an algorithmic approach to CS care. Though debated, MCS is also highly likely to improve CS outcomes when applied appropriately, which further supports a multidisciplinary shock team approach to patient and device selection. Summary: Shock teams likely improve patient outcomes by facilitating early patient phenotyping and appropriate intervention. Institutions should strongly consider adopting a multidisciplinary shock team approach to CS care, though additional data supporting these interventions are needed.
MeSH term(s)	Heart-Assist Devices ; Humans ; Multicenter Studies as Topic ; Registries ; Shock, Cardiogenic/therapy
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	645186-x
ISSN	1531-7080 ; 0268-4705
ISSN (online)	1531-7080
ISSN	0268-4705
DOI	10.1097/HCO.0000000000000967
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Article ; Online: Pulmonary Hypertension in HIV.

Basyal, Binaya / Jarrett, Harish / Barnett, Christopher F

The Canadian journal of cardiology

2018 Volume 35, Issue 3, Page(s) 288–298

Abstract: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is important to recognize given its association with significant morbidity and mortality. With the introduction of antiretroviral therapy, the focus of disease management ... ...

Abstract	Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is important to recognize given its association with significant morbidity and mortality. With the introduction of antiretroviral therapy, the focus of disease management has largely shifted from treating immunodeficiency-related opportunistic infections to managing chronic cardiopulmonary complications. Symptoms are nonspecific, and a high index of clinical suspicion is needed to avoid significant delay in the diagnosis of HIV-PAH. Although several viral proteins have been implicated in the pathogenesis of HIV-PAH, the exact mechanism remains uncertain. Further studies are needed to elucidate precise pathogenic mechanisms, early diagnostic tools, and novel therapeutic targets to improve prognosis of this severe complication.
MeSH term(s)	Early Diagnosis ; HIV Infections/complications ; HIV Infections/immunology ; HIV Infections/virology ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/physiopathology ; Hypertension, Pulmonary/prevention & control ; Prognosis
Language	English
Publishing date	2018-12-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2019.01.005
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Article ; Online: Neurogenic Stunned Myocardium in Severe Neurological Injury.

Kenigsberg, Benjamin B / Barnett, Christopher F / Mai, Jeffrey C / Chang, Jason J

Current neurology and neuroscience reports

2019 Volume 19, Issue 11, Page(s) 90

Abstract: Purpose of review: Neurogenic stunned myocardium (NSM) is a poorly recognized cardiac manifestation of neurological illness. This review addresses the contemporary understanding of NSM pathophysiology, epidemiology, diagnosis, and clinical management.!## ...

Abstract	Purpose of review: Neurogenic stunned myocardium (NSM) is a poorly recognized cardiac manifestation of neurological illness. This review addresses the contemporary understanding of NSM pathophysiology, epidemiology, diagnosis, and clinical management. Recent findings: While the precise pathophysiology and diagnosis remain unclear, NSM is phenotypically atypical stress cardiomyopathy that can be partially attributed to excess catecholaminergic toxicity. NSM is a diagnosis of exclusion where electrocardiography, echocardiography, and cardiac biomarkers are frequently abnormal. Clinical expertise is crucial to evaluate and differentiate NSM from acute coronary syndrome and in the evaluation of potential cardiac transplantation donors after unsalvageable severe neurological injury. Neurogenic stunned myocardium is a relatively common and clinically impactful condition. More research is needed, particularly to refine clinical prognostication of NSM and rule out intrinsic cardiac injury in order to optimize donor candidacy in the event of brain death.
MeSH term(s)	Acute Coronary Syndrome/diagnosis ; Diagnosis, Differential ; Donor Selection/methods ; Humans ; Myocardial Stunning/diagnosis ; Myocardial Stunning/epidemiology ; Myocardial Stunning/physiopathology ; Myocardial Stunning/therapy
Language	English
Publishing date	2019-11-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057363-7
ISSN	1534-6293 ; 1528-4042
ISSN (online)	1534-6293
ISSN	1528-4042
DOI	10.1007/s11910-019-0999-7
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