• Stefan Williams, Antonis Kalakoutas, Segun Olusanya, Benedict Schrage, Guido Tavazzi, Anthony P Carnicelli, Santiago Montero, Christophe Vandenbriele, Adriana Luk, Hoong Sern Lim, Sai Bhagra, Sascha C Ott, Marta Farrero, Marc D Samsky, KennedyJamie L WJLWHeart Failure / Transplant Program, Inova Heart and Vascular Institute, Falls Church, VA, USA., Sounok Sen, Richa Agrawal, Penelope Rampersad, Amanda Coniglio, Federico Pappalardo, Christopher Barnett, and Alastair G Proudfoot.
• Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
• Crit Care. 2024 Apr 2; 28 (1): 105105.

BackgroundObservational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF.MethodsA 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1-3 as inappropriate, 4-6 as uncertain and as 7-9 appropriate).ResultsOf the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS.ConclusionThis study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.© 2024. The Author(s).

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