Systems of Care in Cardiogenic Shock

Aponte, Maria M. Patarroyo; Manrique, Carlos; Kar, Biswajit

doi:10.14797/mdcj-16-1-50

Cited by 11 publications

(8 citation statements)

References 37 publications

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“…Among 30279 pa tients hospitalized with a diagnosis of shock, in 52.1% (n = 15 779) of cases, the shock was cardiogenic, including 8057 patients with MIrelated CS. Patients with MICS, compared to those with nonMIrelated CS, did not sig nificantly differ in mean age (70.0 [11.4] vs. 70.0 [13.6]; P = 0.84), length of hospitalization (7 [2-16] vs. 7 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] days; P = 0.42), and incidence of diabetes mellitus (34.0% vs. 35.1%; P = 0.13), but they were less often females (41.4% vs. 44.5%; P <0.001), and had lower incidence of hyperten sion (69.3% vs. 72.3%; P <0.001) and atrial fibrillation (10.5% vs. 23.3%; P <0.001). The majority (81%) of MICS patients were treated invasively.…”

Section: Resultsmentioning

confidence: 99%

Management of patients with myocardial infarction complicated by cardiogenic shock: Data from a comprehensive all-comer administrative database covering a population of 4.4 million

Gąsior,

Tajstra,

Cieśla

et al. 2024

Pol Heart J

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Section: Resultsmentioning

confidence: 99%

Management of patients with myocardial infarction complicated by cardiogenic shock: Data from a comprehensive all-comer administrative database covering a population of 4.4 million

Gąsior,

Tajstra,

Cieśla

et al. 2024

Pol Heart J

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“…Through the same process, spoke hospitals would obtain accreditation as Level II and Level III centers. This 3-tiered system, similar to what is seen in trauma care, has been previously proposed by some authors (2,7,32). In this model, a Level III center would identify patients in or at risk of CS and triage them to a Level II or I center within the region depending on the patient's needs.…”

Section: Discussionmentioning

confidence: 98%

“…Published data from formally established models in Spain and in the Mayo Clinic in Arizona showed increased survival rates using this approach ( 14 , 31 ). Distances between spokes and hub centers can be a limitation in certain areas like the rural United States, where immediate transfer may require a large amount of resources ( 14 , 32 ).…”

Section: Current Initiativesmentioning

confidence: 99%

Systems of Care in Cardiogenic Shock

Villela

Clark

William

et al. 2021

Front. Cardiovasc. Med.

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Outcomes for cardiogenic shock (CS) patients remain relatively poor despite significant advancements in primary percutaneous coronary interventions (PCI) and temporary circulatory support (TCS) technologies. Mortality from CS shows great disparities that seem to reflect large variations in access to care and physician practice patterns. Recent reports of different models to standardize care in CS have shown considerable potential at improving outcomes. The creation of regional, integrated, 3-tiered systems, would facilitate standardized interventions and equitable access to care. Multidisciplinary CS teams at Level I centers would direct care in a hub-and-spoke model through jointly developed protocols and real-time shared decision making. Levels II and III centers would provide early access to life-saving therapies and safe transfer to designated hub centers. In regions with large geographical distances, the implementation of telemedicine-cardiac intensive care unit (CICU) care can be an important resource for the creation of effective systems of care.

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“…The introduction of the hub-and-spoke model has a positive impact on patient outcomes [ 124 , 125 , 126 ]. The “hub” hospital has the central role, warranting the presence of a multidisciplinary CS team consisting of the interventional cardiologist, critical care specialist, cardiothoracic surgeon and advanced heart failure specialist (Level of care I).…”

Section: Shock Teams and Networkmentioning

confidence: 99%

Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

Polyzogopoulou

Bezati

Karamasis

et al. 2023

JCM

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Cardiogenic shock is a complex syndrome manifesting with distinct phenotypes depending on the severity of the primary cardiac insult and the underlying status. As long as therapeutic interventions fail to divert its unopposed rapid evolution, poor outcomes will continue challenging health care systems. Thus, early recognition in the emergency setting is a priority, in order to avoid delays in appropriate management and to ensure immediate initial stabilization. Since advanced therapeutic strategies and specialized shock centers may provide beneficial support, it seems that directing patients towards the recently described shock network may improve survival rates. A multidisciplinary approach strategy commands the interconnections between the strategic role of the ED in affiliation with cardiac shock centers. This review outlines critical features of early recognition and initial therapeutic management, as well as the utility of diagnostic tools and risk stratification models regarding the facilitation of patient trajectories through the shock network. Further, it proposes the implementation of precise criteria for shock team activation and the establishment of definite exclusion criteria for streaming the right patient to the right place at the right time.

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Systems of Care in Cardiogenic Shock

Cited by 11 publications

References 37 publications

Management of patients with myocardial infarction complicated by cardiogenic shock: Data from a comprehensive all-comer administrative database covering a population of 4.4 million

Management of patients with myocardial infarction complicated by cardiogenic shock: Data from a comprehensive all-comer administrative database covering a population of 4.4 million

Systems of Care in Cardiogenic Shock

Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

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