HF-CS: New Standard for Therapy and Definition of Success?

Heart failure cardiogenic shock (HF-CS) remains a leading cause of morbidity and mortality despite advances in mechanical circulatory support (MCS). Much of the available data on temporary MCS (tMCS) is derived from acute myocardial infarction–related cardiogenic shock, leaving uncertainty in HF-CS management.

In this debate-style session, experts will examine whether percutaneous LVADs (e.g., Impella) should be used as first-line therapy or whether lower-intensity support (e.g., intra-aortic balloon pump) should be initiated first. Discussion will consider shock severity, patient phenotype, device-related complications, and implications for hub-and-spoke care models.

A second debate will focus on defining success in future HF-CS trials—whether outcomes should prioritize survival, successful bridging to advanced therapies (e.g., durable LVAD or transplant), or quality of life. Faculty will highlight lessons from recent trials and key considerations for future study design.

Learning Objectives

• Review recent data on temporary MCS use in HF-CS, including appropriate use of intra-aortic balloon pump and percutaneous LVADs.
• Understand key considerations in device selection, including shock severity, phenotype, vascular access, and hospital capabilities.
• Identify meaningful outcome measures in HF-CS, including survival, bridging to advanced therapies (e.g., transplant or durable LVAD), and quality-of-life metrics.