Survival 6

Critical hours in heart failure cardiogenic shock
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Cardiogenic Shock Prevalence is Rapidly Growing

The increase is explained by:

 

  • Improved diagnosis
  • Improved awareness
  • Aging population
  • Rising CV risk factors

Heart Failure Cardiogenic Shock (HFCS):

Rising crisis in HFCS

Protocols exist for AMICS, but HFCS remains an under researched clinical need.

Race against time for survival

When treating patients in heart failure cardiogenic shock, delays can significantly impact outcomes.

Data emerges

Impella 5.5 as first line improves survival to 86.5%, stabilizing patients for optimal long-term recovery and treatment strategies.1,2,3

Decompensation occurs rapidly in HFCS1

 

  • 6 hours

    Emerging evidence indicates that this progression may occur even earlier in HFCS, often within the first 6 hours.

  • >50%

    of patients in SCAI stages B/C shock progress to more severe stages within 24 hours.

  • >90%

    of patients in SCAI stage B at baseline will decompensate to more severe shock.

The first 6 hours of Heart Failure Cardiogenic Shock (HFCS) are critical

Many patients remain in advanced shock stages (D and E) throughout their stay, highlighting the clinical challenge of managing cardiogenic shock.

Shock progression has a dynamic and high-risk nature, with mortality linked closely to higher SCAI stages and lack of improvement over time. 

Lactate levels emerge as key survival indicator

Lactate levels serve as a crucial marker of survival in patients with cardiogenic shock. Patients with baseline SCAI C to E shock who died from CS diagnosis by 24 hours had significantly higher lactate than survivors.10 

This reinforces the importance of early CS diagnosis.

Impella’s ability to support cardiac output may help in reducing lactate levels.10

Time to transfer

Time to transfer

It took ~3x longer to transfer HFCS patients than AMICS patients to higher acuity centers⁶

Hub center HFCS relative mortality

Hub center HFCS relative mortality

45% higher relative mortality for transfer patients⁶

Impella 5.5 as first line

Best practices coupled with prolonged Impella 5.5 + support allow heart recovery and patient optimization.4 

  • Complete weaning of catecholamines (VIS=0)
  • Early GDMT
  • Initiation of physical therapy
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Impella 5.5 transforms outcomes

Impella 5.5 use in HFCS may enhance survival1,4 supporting native heart recovery or bridge to decision.15

Impella 5.5 product details
Impella 5.5 as first line MCS

Impella 5.5 as first line MCS

SURPASS 2025 (n=444 patients)¹

Survival rates in heart failure-related cardiogenic shock

Survival rates in heart failure-related cardiogenic shock

HFCS treatment with Impella 5.5 alone rather than multiple MCS devices was associated with better survival and reduced complications¹

Early identification & phenotyping supports optimal patient management decisions

Dynamic assessment is critical 

  • Early PAC use (≤6 hrs of admission) lowers mortality9
  • Lactate clearance is critical10 
  • SCAI stage improvement predicts survival7

References

  1. Abraham, J. et al., (2025). Impella 5.5 support for heart failure-related cardiogenic shock and 1-year survival insights from a multi-center registry [presentation]. In: Technology and Heart Failure Therapeutics (THT) Conference; 2025 February 11-13; Boston MA.
  2. Kwon, J. H., et al., (2024). Patient Characteristics and Early Clinical Outcomes With Impella 5.5: A Systematic Review and Meta-Analysis. ASAIO journal (American Society for Artificial Internal Organs : 1992), 70(7), 557–564. https://doi.org/10.1097/MAT.0000000000002169
  3. Fried, J. et al., (2024). Clinical outcomes among cardiogenic shock patients supported with high-capacity Impella axial ow pumps: A report from the Cardiogenic Shock Working Group. The Journal of heart and lung transplantation : the ocial publication of the International Society for Heart Transplantation, 43(9), 1478–1488. https://doi.org/10.1016/j.healun.2024.05.015
  4. Bandini, M. et al., (2024). Midterm outcomes of patients with native heart recovery after 5+ for cardiogenic shock. European journal of heart failure, 10.1002/ejhf.3544. Advance online publication. https://doi.org/10.1002/ejhf.3544
  5. Basuray, A. et al., (2014). Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes. Circulation, 129(23), 2380–2387. https://doi.org/10.1161/CIRCULATIONAHA.113.006855
  6. Garan, A. R. et al., (2024). Outcomes of Patients Transferred to Tertiary Care Centers for Treatment of Cardiogenic Shock: A Cardiogenic Shock Working Group Analysis. Journal of cardiac failure, 30(4), 564–575. https://doi.org/10.1016/j.cardfail.2023.09.003
  7. Jentzer, J. C., et al., (2023). Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients. Journal of the American Heart Association, 12(23), e032748. https://doi.org/10.1161/JAHA.123.032748
  8. Hernandez-Montfort, J. J., et al. (2023). Clinical presentation and in-hospital trajectory of heart failure and cardiogenic shock. JACC: Heart Failure, 11(2), 176–187. https://doi.org/10.1016/j.jchf.2022.10.002
  9. Kanwar, M. K. et al., (2023). Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock. Journal of cardiac failure, 29(9), 1234–1244. https://doi.org/10.1016/j.cardfail.2023.05.001
  10. Ton, V. K. et al., (2024). Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report. Journal of the American College of Cardiology, S0735-1097(24)07740-4. Advance online publication. https://doi.org/10.1016/j.jacc.2024.04.069
  11. Zweck, E. (2024). Improving risk stratification of SCAI stages of cardiogenic shock with machine learning-based phenotyping: Data from the Cardiogenic Shock Working Group [Presentation]. Presented at TCT Conference 2024.
  12. Naidu, S. S., et al.,  (2022). SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies... Journal of the Society for Cardiovascular Angiography & Interventions, 1(1), 100008. https://doi.org/10.1016/j.jscai.2021.100008
  13. Osman, M., et al., (2021). Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States. Journal of the American Heart Association, 10(15), e021061. https://doi.org/10.1161/JAHA.121.021061
  14. Schrage, B., et al., (2023). Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. European journal of heart failure, 25(4), 562–572. https://doi.org/10.1002/ejhf.2796
  15. Feng, I., Dardik, G., Kaku, Y., Zhao, Y., Del Carmen, H., DePaolo, J., Cevasco, M., Biscotti, M., Wald, J. W., Fried, J. A., & Takeda, K. (2025). Outcomes of prolonged support on surgically implanted microaxial left ventricular assist devices for refractory cardiogenic shock. JTCVS Open, 25, 173–189. https://doi.org/10.1016/j.xjon.2025.03.023

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