Enhancing Care in Cardiogenic Shock: Role of Palliative Care in Acute Cardiogenic Shock Through Destination Therapy
Bibliographic record
Abstract
Despite advances in the management of cardiogenic shock (CS), morbidity and mortality in CS remain exceedingly high and one third of patients do not survive their admission. Palliative care (PC) is an interdisciplinary approach focussed on improving the quality of life of patients and families facing life-threatening illness. Rates of PC use in CS remain low, despite evidence suggesting decreased symptom burden and reduced use of health care in patients with heart failure and in critical care settings. PC should occur in tandem with mobilization of aggressive life-sustaining measures such as mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) in the care of patients presenting with CS. In this review, we describe the role of PC throughout the care continuum of patients with acute CS through to destination therapy with a left ventricular assist device. We explore the current use of PC in CS and challenges to goals-of-care discussions posed by MCS and ECMO, and highlight strategies on integrating PC in acute and chronic CS. Finally, we demonstrate the importance of incorporating PC early in management and challenge the traditional use of PC primarily as an end-of-life intervention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".