When multidisciplinary health care teams were engaged in caring for patients suffering from refractory cardiogenic shock, a severe condition that can occur after a heart attack, the likelihood of survival increased significantly, by approximately 50 percent. The proof of concept study by investigators at University of Utah Health was published online in the July issue of Circulation.
Patients seen by a multidisciplinary team had a 75 percent chance of survival at 30 days compared to a 50 percent survival rate for those treated before the new approach was implemented. The study, carried out at University Hospital in Salt Lake City, included 123 patients admitted between April 2015 and August 2018 and compared their data with the immediately preceding 121 patients.
"These patients are the sickest of the sick," says Iosif Taleb, M.D., first author of the study and a postdoctoral fellow in cardiology at U of U Health. "Taking a multidisciplinary approach provided a strong survival benefit compared to standard of care treatment."
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Refractory cardiogenic shock happens after the heart and circulatory system fail despite optimal medical management, resulting in a lack of blood to adequately fuel organs in the body. To remedy the life-threatening situation, increasingly these patients are connected to a device that mechanically circulates the blood. Despite intervention, 40 to 50 percent die within 30 days. These grim statistics have remained steady worldwide for the past 30 years.
Because of differences in the cause of cardiogenic shock between patients and complexities associated with treating their condition, no published medical guidelines exist for this population. Stavros Drakos, M.D., Ph.D., senior author of the study and medical director of the heart failure and mechanical circulatory support program at U of U Health, wondered whether tapping into existing collaborations within the cardiovascular team could improve the situation for this subset of heart failure patients whose outcomes are amongst the worst.
To test the idea, Drakos and colleagues assembled providers into a single Shock Team. Comprised of a heart failure cardiologist, a cardiothoracic surgeon, an interventional cardiologist and an intensive care unit physician, together they combine their expertise to make decisions regarding each patient's treatment and care. That includes the best type of mechanical circulatory support, how adverse events that arise should be treated and other clinical and follow-up care decisions.