Inclusion Criteria:

• 1. Over 18 years of age
• 2. Ejection fraction \<40%
• 3. Cardiogenic shock defined by clinical criteria (including any of: lactate \>2.5 mmol/L, systolic blood pressure \<90 mmHg, acute kidney or liver injury, or cardiac index \<2.1 on hemodynamic monitoring) plus the clinical requirement for at least one pressor, inotrope, or temporary mechanical circulatory support device (MCSD)

Exclusion Criteria:

• 1. History of LVAD or other durable ventricular assist device
• 2. An identified clinical disorder associated with skeletal muscle weakness/wasting (e.g., muscular dystrophy, mitochondrial disorder, active cancer, modified Rankin score greater or equal to 4 post-stroke
• 3. Chronic enteric and parenteral nutrition support patients
• Intubation or prior history of heart transplantation are not exclusion criteria if the inclusion criteria are otherwise met.