A Regionalized Network to Improve Care for Cardiogenic Shock
Cardiogenic shock is a time-sensitive and challenging condition to treat. As a result, short-term survival rates for patients with cardiogenic shock have historically been low – approximately 50% die within 30 days. It remains the most common cause of death in patients hospitalized after a heart attack or with heart failure.
"Treating this condition requires advanced knowledge, meticulous care and coordinated efforts among multiple specialists."
– Behnam Tehrani, MD
Beginning in 2017, IHVI significantly improved its patient survival rates using a standardized protocol employed by a multidisciplinary team that increased survival rates to more than 70%. IHVI then focused on expanding use of its team and protocol across a regional network of hospitals. Inova’s team recently published results of its work in the October 2022 issue of JACC: HF, entitled "A Standardized and Regionalized Network of Care for Cardiogenic Shock." The article demonstrates the impact of using a systems-of-care, or "hub-and-spoke," approach to clinical management to extend these survival benefits across a larger geography.
Challenges of treating cardiogenic shock
Cardiogenic shock requires a timely and multidimensional response with input and expertise across several medical specialties. Patients in cardiogenic shock can progress to multiorgan failure, and ultimately death, within hours.
"Implementing the correct response and treatment strategy can be tricky, as the cause of cardiogenic shock is not always clear at its onset," according to Behnam Tehrani, MD.
"Even when physicians halt the progression of multiorgan system failure, patients may require high-level treatments such as mechanical circulatory support devices to include ECMO (extracorporeal membrane oxygenation)," Dr. Tehrani continued. “And, in the event the native heart does not recover, patients may require cardiac replacement therapies such as an LVAD or heart transplantation."
Using a hub-and-spoke model for cardiogenic shock
IHVI's Inova Fairfax Medical Campus location serves as a central hub to manage cardiogenic shock cases from across the region. It provides a full spectrum of interventional cardiology, cardiovascular surgery, advanced heart failure and cardiac critical care capabilities, with an American Heart Association Level 1 Cardiac ICU and a multidisciplinary shock team of specialists who are on call and available around the clock.
To aid in improving outcomes across the region’s hospitals, Inova serves as a destination center, or "hub," to more than 30 "spoke" hospitals with Level 2 and 3 capabilities. As the hub, IHVI provides 24/7 support via timely, efficient and coordinated access to its multidisciplinary cardiogenic shock team, including specialists in:
- Advanced heart failure
- Cardiovascular critical care
- Cardiac surgery
- Interventional cardiology
- Emergency medicine
"All the hospitals across this regional network are encouraged to follow a standardized protocol to identify cardiogenic shock quickly, stabilize patients, manage those they can, and transfer those who may require more advanced treatments or expertise," Alex Truesdell, MD, said. "These spoke hospitals look to the cardiogenic shock team at IHVI for consultative guidance and support around patient management and transport decisions."
Through this regionalized network, outcomes have improved for all patients, including those who presented first to a "spoke" hospital prior to being transferred to IHVI for care.