Patients with cardiogenic shock need defined pathways of escalation and care to improve survival.
Cardiogenic shock (CS) occurs when a cardiac disorder means it can no longer supply adequate blood and oxygen to vital organs. This causes a life-threatening state known as hypoperfusion that can rapidly lead to multi-organ failure and death.
Nearly 1 in 10 patients suffering from a heart attack will develop cardiogenic shock, and upto half of patients will not survive to hospital discharge.
These high death rates are partly attributable to delays in recognition of CS and subsequent timely access to the evidence-based interventions and expertise required for optimal patient management.
Early identification of CS, rapid intervention to reverse the underlying cause, and immediate haemodynamic stabilisation with or without the use of mechanical circulatory support (MCS) technologies are vital to improve survival. Observational data suggest that input and support from specialist multidisciplinary CS teams (CS-MDT) at an early stage in the patient pathway impacts survival. The CS-MDT provides 24/7 case-based discussion and treatment recommendations up to and including transfer to the CS Centre where indicated. Similarly, and in parallel with other acute illnesses such as stroke and myocardial infarction, cohorting of patients in regional, specialist CS Centres, is likely to improve patient outcomes. CS Centres acting as the hub of a regional network would provide the entire spectrum of cardiac diagnostics and therapeutics and access to invasive haemodynamic monitoring and MCS technologies required to manage this complex and dynamic condition. CS Centres also work closely with supra-regional Advanced Heart Failure Centres (AHFCs), where not colocated, to ensure all patients with CS who might benefit from advanced heart failure therapies including heart transplant are discussed.
The cardiology Getting it Right First Time (GIRFT) report emphasises the importance of networked models of care. Robust process, efficient pathways and effective training and education across networks are likely to be the first step towards improving clinical outcomes in CS.
In this document, we outline several recommendations as part of a systems approach to improving patient survival and experience. These include but are not limited to:
The national Cardiac Pathway Improvement Programme (CPIP) represents an opportunity to embed many of these recommendations, to potentially transform outcomes in these patients, and CPIP leaders nationally and regionally should work with stakeholders and CS experts to implement them.