Systems of Care in Cardiogenic Shock

Miguel Alvarez Villela; Rachel Clark; Preethi William; Daniel B Sims; Ulrich P Jorde

doi:10.3389/fcvm.2021.712594

Systems of Care in Cardiogenic Shock

Front Cardiovasc Med. 2021 Sep 16:8:712594. doi: 10.3389/fcvm.2021.712594. eCollection 2021.

Authors

Miguel Alvarez Villela^{1

2}, Rachel Clark¹, Preethi William^{1

3}, Daniel B Sims¹, Ulrich P Jorde¹

Affiliations

¹ Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.
² Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States.
³ Division of Cardiology, Banner University Medical Center, Tucson, University of Arizona, Tucson, AZ, United States.

Abstract

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.

Keywords: AHF-CS; AMI-CS; cardiogenic shock; hub and spoke; shock team; systems of care.

Publication types

Review