The largest impact on CS care will now occur by finding the “recipe” for HF-CS similar to what has occurred in AMI-CS. What are the most important HF-CS decisions you make? Comment on others you find important. Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur

Babar Basir Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur This is a great Q. Algorithm/protocol. Early diagnosis remains a challenge; tempo of reassessment, & appr. escalation.♥️ recovery is so rewarding yet it seems we’re not recovering as much as we could. Also, humbling to know that different sites across US practice very differently

Rachna Kataria, MD Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Great answers Rachna Kataria, MD Anju Bhardwaj MD FACC Ajay V. Srivastava MD but those are hard questions to answer in a clinical trial. Are you suggesting we aren’t ready to do a RCT in HF-CS? You all are leading this space and now I am curious to what you think?

Babar Basir Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Ajay V. Srivastava MD That’s a great Q, glad you asked. We certainly need trials & need to be willing to randomize. I’m looking forward to Alt shock 2. However, 1st: HF CS comes in two broad flavors - de novo & ACHF - & we’re learning these are very diff. 2nd: shock clock in HF CS is harder to..(1/2)

Babar Basir Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Ajay V. Srivastava MD ..define. We’ll need strict hemometabolic parameters for inclusion. 3: for many of the AoC HFCS pts, intent to bridge to VAD/txp drives therapies. For RCT purposes, we’ll need weaning protocols (including # of attempts at weaning). Much to be learned from registries. (2/2)

Babar Basir Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Ajay V. Srivastava MD Lastly, I do think the more broadly applicable question that impacts the community - when to escalate and to what - is more important. Don’t think there will ever be a perfectly homogenous CS population, but we’ll have to get creative! Great to have + and -ve RCTs to learn from!

Rachna Kataria, MD Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Ajay V. Srivastava MD Great thoughts Rachna, should be a big discussion point during the upcoming months.

Babar Basir Rachna Kataria, MD Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Babar Basir sorry, I misunderstood your question. Thought you meant what would have the biggest impact for AMI CS in real world. As you’ve demonstrated in Detroit CSI, teams/institutions/ protocols & admin support is crucial & device Rx/selection just a part of that protocol

Ajay V. Srivastava MD Rachna Kataria, MD Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Though twitter conversation. Good one for scripps HF symposium 😜 Rola Khedraki, MD, FACC

Babar Basir Ajay V. Srivastava MD Rachna Kataria, MD Jennifer Cowger Iyad Isseh إياد نبيل العسّة Anju Bhardwaj MD FACC Jason N. Katz Navin Kapur Rola Khedraki, MD, FACC “Let’s take this offline” 🤪 looking forward to Scripps shock - first shock meeting post Danger!
Rola Khedraki, MD, FACC