Cardiogenic Shock Survivorship: A Multidisciplinary Approach Across the Continuum of Care

Abstract

Cardiogenic shock (CS) is a complex and heterogeneous clinical syndrome associated with high short-term mortality as well as a long-term burden of morbidity. Whereas short-term survival has improved owing to early recognition, revascularization, and temporary mechanical circulatory support (tMCS), survival after hospital discharge remains poorly defined. A large number of CS survivors experience persistent myocardial dysfunction, neurocognitive impairment, psychological distress, frailty, and recurrent heart failure hospitalizations. Yet current clinical guidelines and research frameworks provide limited direction beyond the acute phase, underscoring the urgent need for a structured longitudinal approach to care. This State-of-the-Art Review proposes the Cardiogenic Shock Survivorship Continuum, a novel framework delineating 3 interdependent phases: acute rescue and stabilization, assessment and optimization of in-hospital trajectories, and postdischarge shock care. The acute phase focuses on timely diagnosis, end-organ support, and individualized tMCS strategies. The in-hospital phase emphasizes diagnostic reassessment, heart failure guideline-directed medical therapy initiation, and procedural interventions targeting reversible pathophysiology. The postdischarge phase advocates for structured outpatient models, multidisciplinary postshock clinics, individualized risk stratification, re-referral for advanced therapies when appropriate, and recovery-focused rehabilitation. This review underscores the need to redefine success in CS, identifies critical gaps in evidence, and proposes future directions in research, clinical infrastructure, and collaborative networks to advance the field. Optimizing care in CS requires a paradigm that emphasizes both short- and long-term survival, with emphasis on achieving functional recovery, stability in health status, and preservation of quality of life.

Keywords: cardiogenic shock; guideline-directed therapy; heart failure; mechanical circulatory support; multidisciplinary care; post–intensive care syndrome; recovery; rehabilitation; remission; survivorship.