Team-care approach increases chances of survival with refractory cardiogenic shock

When multidisciplinary health care teams cared for patients with refractory cardiogenic shock, a serious condition that may occur after a heart attack, the likelihood of survival increased significantly by about 50%. The proof-of-concept study conducted by researchers at the University of Utah Health was published online in the July issue of circulation.

Patients examined by a multidisciplinary team had a 75% chance of survival at 30 days, compared to 50% for those treated before the implementation of the new approach. The study, conducted at the University Hospital of Salt Lake City, included 123 patients admitted between April 2015 and August 2018 and compared their data to the 121 immediately preceding patients.

These patients are the sickest patients. The adoption of a multidisciplinary approach has provided a significant advantage in terms of survival compared to standard treatment. "

Iosif Taleb, M.D., first author of the study and postdoctoral fellow in cardiology at the U of Health

Refractory cardiogenic shock occurs after failure of the heart and circulatory system despite optimal medical management, resulting in a lack of blood to properly supply the organs of the body. To remedy the potentially life-threatening situation, these patients are increasingly connected to a device that circulates blood mechanically. Despite the intervention, 40 to 50% of people die within 30 days. These sad statistics have remained stable worldwide over the past 30 years.

Because of the differences in the cause of cardiogenic shock between patients and the complexities badociated with the treatment of their condition, there is no published medical guideline for this population. Stavros Drakos, MD, Ph.D., lead author of the study and Medical Director of the Heart Failure and Circulatory Support Program at the University of Health, It was asked if the use of existing collaborations within the cardiovascular team could improve the situation of this subset. heart failure patients whose results are among the worst.

To test this idea, Drakos and his colleagues brought the suppliers together into a single Shock team. Composed of a cardiologist specializing in heart failure, a cardiothoracic surgeon, an interventional cardiologist and a doctor of intensive care units, they combine their expertise to take decisions about the treatment and care of each patient. This includes the best type of mechanical circulatory support, how adverse events should be treated, and other decisions regarding clinical care and follow-up.

The approach has improved the 30-day survival rate for discharged patients and those who remained at the hospital, whether they were initially admitted to the university hospital or transferred to the hospital. 39, a reference hospital. Team decision making did not have a significant impact on the speed of care, as measured by the time elapsed between the presentation of refractory cardiogenic shock and placement on a mechanical support.

Antigone Koliopoulou, M.D., co-author and cardiothoracic surgeon at the University of Health, explains that their success stems from the collective wisdom of the team. "We believe that having a consensual medical decision while carefully discerning the positive and negative aspects of each patient's case from the point of view of all the medical specialties involved is more likely to be appropriate in relation to the decision of an individual doctor, "she says.

At the university hospital, where the study was conducted, the Shock team remains the standard practice in care, demonstrating that the approach is sustainable. Larger clinical trials will need to be conducted to evaluate effectiveness in different populations and hospitals.

"This work demonstrates that results can be improved when the research and teaching aspects of such clinical programs are developed in close relationship," Drakos said. "Parallel development is mutually beneficial and has just closed the loop, increasing the potential of both research and clinical care and patient care"