Behnam Tehrani, MD

Behnam Tehrani, MD

Co-Director, Cardiogenic Shock Program, IHVI
Co-Director, Cardiac Catheterization Laboratories, Inova Fairfax Medical Campus

Dr. Tehrani is board certified in interventional cardiology and cardiovascular disease and sees patients at the Inova Cardiology – Fairfax and Ashburn offices.

Bio

Alexander Truesdell, MD

Alexander Truesdell, MD

Co-Director, Cardiogenic Shock Program

Dr. Truesdell is board certified in interventional cardiology and cardiovascular disease and sees patients at the Virginia Heart – Fairfax office.

Bio

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.

Critical factors in treating cardiogenic shock

The cardiogenic shock team credits three factors with the program’s success:

Collaboration
More than half of patients with cardiogenic shock ultimately treated at Inova Fairfax Medical Campus initially present at a spoke hospital and are transferred. Spoke hospitals can access the entire cardiogenic shock team through a “one-call” approach – specialists in all relevant disciplines can be reached simultaneously, 24/7, using one point of contact.

Communication
The team welcomes consultations and phone calls from partner hospitals as often as needed to discuss ongoing treatment and possible transfer of patients. Check-ins follow the initial consultation at 8, 16 and 24 hours, and in between as needed.

Multidisciplinary approach
Uniting specialists from multiple disciplines allows for collaborative, expert decision making and a tailored approach to care. The team considers the complexity of each case, along with the patient’s health condition and health values to employ a selective strategy for optimal outcomes.

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