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Review
. 2023 Dec 12;82(24):2329-2337.
doi: 10.1016/j.jacc.2023.09.828.

Research Priorities in Critical Care Cardiology: JACC Expert Panel

P Elliott Miller  1 , Kurt Huber  2 , Erin A Bohula  3 , Konstantin A Krychtiuk  4 , Janine Pöss  5 , Robert O Roswell  6 , Guido Tavazzi  7 , Michael A Solomon  8 , Steen D Kristensen  9 , David A Morrow  3 ; ACC’s Critical Care Cardiology Member Section and the ESC Association for Acute CardioVascular Care
Affiliations
Review

Research Priorities in Critical Care Cardiology: JACC Expert Panel

P Elliott Miller et al. J Am Coll Cardiol. .

Abstract

Over the last several decades, the cardiac intensive care unit (CICU) has seen a substantial evolution in the patient population, comorbidities, and diagnoses. However, the generation of high-quality evidence to manage these complex and critically ill patients has been slow. Given the scarcity of clinical trials focused on critical care cardiology (CCC), CICU clinicians are often left to extrapolate from studies that either exclude or poorly represent the patient population admitted to CICUs. The lack of high-quality evidence and limited guidance from society guidelines has led to significant variation in practice patterns for many of the most common CICU diagnoses. Several barriers, both common to critical care research and unique to CCC, have impeded progress. In this multinational perspective, we describe key areas of priority for CCC research, current challenges for investigation in the CICU, and essential elements of a path forward for the field.

Keywords: cardiac intensive care unit; mechanical circulatory support; research methods; shock.

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Conflict of interest statement

Funding Support and Author Disclosures Drs Bohula and Morrow are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott Laboratories, Abiomed, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Daiichi-Sankyo, Intarcia, Janssen, Merck, Novartis, Pfizer, Poxel, Quark Pharmaceuticals, Regeneron, Roche, Siemens, and Zora Biosciences. Dr Pöss receives institutional research fees from the German Cardiac Society, German Heart Research Foundation, Dr Rolf M. Schwiete Foundation and Getinge. Dr Solomon receives research support from the National Institutes of Health Clinical Center intramural research funds. Dr Kristensen is National Coordinator of the SOS-AMI study (Idorsia departmental grant). Dr Morrow has received consulting fees from Abbott Laboratories, Arca Biopharma, InCarda, Inflammatix, Merck, Novartis, and Roche Diagnostics. Dr Krychtiuk has received speaker fees from Zoll Medical, Sanofi, and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Key areas of research collaboration across specialties.
Venn diagraph showing the overlap between acute cardiovascular topics, various specialties, and critical care cardiology. MCS = Mechanical circulatory support; AMI-CS = Acute myocardial infarction-cardiogenic shock; ADHF = Acute decompensated heart failure; POCUS = Point-of-care ultrasound; VT = Ventricular tachycardia
Figure 2.
Figure 2.. Evidence generation for critical care cardiology.
At the center, evidence based critical care cardiology will require both randomized and real-world data to accomplish each outer goal. Arrows represent the need for constant refinement and reevaluation as new data arises.
Central Illustration.
Central Illustration.. Barriers and potential solutions to research in critical care cardiology.
Barriers to critical care cardiology research are listed on the right and potential solutions on the left. Defining variation both within disease processes and practice variation is a key first step on which to build with broad stakeholder collaboration and trial design innovation.
See this image and copyright information in PMC

References

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