Clinical Investigations Critical Care Medicine www.ccmjournal.org 281 Company and Medtronic and has received research grants from Abbott Vascular and Medtronic. He provided expert testimony for Dartmouth Hitchcock. He received support for travel from Arginox, for participation in executive committee meetings from Arginox, and for development of edu- cational presentations from The Medicines Company. He consulted for Arginox, Medtronic, and The Medicines Company. His institution received grant support from Medtronic, Abbott Vascular, and Arginox Pharmaceu- tical (sponsor of TRIUMPH trial). Dr. Baran lectured for Medtronic and Gilead and consulted for Maquet. His institution received grant support from Arginox Pharmaceutical (sponsor of TRIUMPH trial). Dr. Hochman received support for participation in review activities from Johnson & Johnson Pharmaceutical Research & Development and Bayer HealthCare AG (Independent Data Monitoring Committee for ATLAS 2 ACS-TIMI 51 Trial). She consulted for Glaxo Smith Kline (Steering Committee: SOLID- TIMI 52 and National Coordinator and Steering Committee: STABILITY Trial) and Eli Lily (TRILOGY Steering Committee). She received royalties from Wolters Kluwer Health (UpToDate Chapters). She serves as Senior Guest Editor for Circulation Journal for Partners Healthcare. Dr. Hochman and her institution received an honorarium from Arginox Pharmaceuticals and she served as Global Study Chair from 2005 to 2007. Arbor Pharma- ceuticals donated Nitro-Spray to some ISCHEMIA Trial enrolling sites. Dr. Alexander received grant support from Bristol Myers Squibb, Pfizer, CSL Behring, Phyxius Pharmaceuticals, and Regado Biosciences and lectured for Bristol Myers Squibb. He consulted for Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Pfizer, Daiichi Sankyo, Janssen Pharmaceuticals, Moerae Matrix, Novartis, Orexigen, Regado Biosciences, Somahlution, and Xoma Pharmaceuticals. His institution received grant support and support for travel from Arginox Pharmaceuticals (Grant to Duke University to support past TRIUMPH trial coordinating center activities). Disclosures for Drs. Lopes and Alexander are publically listed at https://www.dcri.org/ about-us/conflict-of-interest. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: sv9@ualberta.ca Objectives: Guidelines recommend β-blockers and renin-angiotensin- aldosterone system blockers to improve long-term survival in hemo- dynamically stable myocardial infarction patients with a reduced left ventricular ejection fraction. The prevalence and outcomes associ- ated with β and renin-angiotensin-aldosterone system blocker ther- apy in patients with ongoing cardiogenic shock is unknown. Design: Secondary analysis of a randomized controlled trial. Setting: In patients with cardiogenic shock lasting more than 24 hours enrolled in Tilarginine Acetate Injection in a Randomized Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e31829f6242 1 Divisions of Critical Care and Cardiology, University of Alberta, Edmon- ton, Alberta, Canada. 2 Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY. 3 Duke Clinical Research Institute, Duke University Medical Center, Dur- ham, NC. 4 Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. 5 Institute of Cardiology, Warsaw, Poland. 6 Wilhelminen Hospital, Vienna, Austria. 7 Third Faculty of Medicine, Charles University Prague, Czech Republic. 8 Robert Wood Johnson Medical School and Cooper University Hospital, Camden, NJ. 9 University of Vermont, Burlington, VT. 10 Newark Beth Israel Medical Center, Newark, NJ. This work was performed at the Duke Clinical Research Institute and at the University of Alberta. Supported, in part, by the Duke Clinical Research Institute. Dr. Reynolds’ institution received grant support and support for travel from Arginox Pharmaceuticals. Dr. Lopes consulted for Bristol-Meyers Squibb, Pfizer, Janssen, and Boehringer Ingelheim and lectured for Bristol-Meyers Squibb and Pfizer. His institution received grant support from Bristol-Meyers Squibb. Dr. Geppert received honorarium from Tilar- ginine Acetate Injection in a Randomized International Study in Unstable MI Patients With Cardiogenic Shock (TRIUMPH) study, received sup- port for travel and participation in review activities from the TRIUMPH study, and lectured for Orion-Pharma and St. Jude. His institution received support for travel from Medtronic, BiotroniK, and Boston Scientific. Dr. Ohman and his institution received grant support from Daiichi Sankyo, Eli Lilly, and Gilead Sciences. He consulted for AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen Pharmaceuticals, Lipscience, Merck, Pozen, Roche, Sanofi Aventis, The Medicines Company, and Wed- bMD. He lectured for Boehringer Ingelheim, Gilead Sciences, Janssen Pharmaceuticals, Liposcience, and The Medicines Company. Dr. Parrillo is a consultant for Artisan, Sangart, and Cytosorbents; he also serves on the Protocol Review Committee and Data Safety Monitoring Boards for the Heart Failure Network, National Heart, Lung and Blood Institute, and National Institute of Health. He has board membership with Artisan, Sangart, and Cytosorbents. His institution received grant support from the Salem Foundation. Dr. Dauerman is a consultant for The Medicines Incidence and Outcomes Associated With Early Heart Failure Pharmacotherapy in Patients With Ongoing Cardiogenic Shock Sean van Diepen, MD, MSc 1 ; Harmony R. Reynolds, MD 2 ; Amanda Stebbins, MSc 3 ; Renato D. Lopes, MD, PhD 3 ; Vladimír Džavík, MD 4 ; Witold Ruzyllo, MD, PhD 5 ; Alexander Geppert, MD 6 ; Petr Widimsky, MD 7 ; E. Magnus Ohman, MD 3 ; Joseph E. Parrillo, MD 8 ; Harold L. Dauerman, MD 9 ; David A. Baran, MD 10 ; Judith S. Hochman, MD 2 ; John H. Alexander, MD, MHS 3