What if patients with the most severe diagnosis after a heart attack were treated in a new way, one that combined the wisdom of several cardiac specialists? This is a question that bothered physicians at the University of Utah, and they set out to see what would happen with a multidisciplinary approach to cardiac care.
Patients who experience a heart attack are already in a severe medical situation, even if they are lucky enough to survive. It can take many months of recovery until the patient feels well, and then, often, the patient needs to make tremendous lifestyle changes to ward off another attack. Right after a heart attack, some survivors experience refractory cardiogenic shock, a condition in which the cardiac and circulatory systems shut down, even though the patient may be in the hospital and receiving the highest level of cardiac care. Sometimes, despite all of the doctor’s best efforts, blood flow cannot reach the heart, and the patient does not survive the incident. About half of these patients do not make it, an unfortunate statistic that has remained stagnant for thirty years.
Iosif Taleb, MD, first author of this study and a postdoctoral fellow in cardiology at The University, said “These patients are the sickest of the sick. Taking a multidisciplinary approach provided a strong survival benefit compared to standard of care treatment.”
Changing the status quo in cardiac care
The study’s lead author was Stavos Drakos, MD, PhD, who was disturbed by the data and considered that forming a collaboration of the subcardiac specialties might increase positive outcomes. Dr. Drakos is Co-Chief of the Heart Failure and Transplant Section at the University of Utah and the Medical Director of the Mechanical Circulatory Support Program at the university. He put the idea into action by gathering a team of doctors, called the shock team, which included a heart failure specialist, a cardiothoracic surgeon, an interventional cardiologist, and an ICU doctor. They met to determine the right course of care for each patient individually. Some of the issues that they give their input into were related to how to proceed in case of unexpected problems and which type of Mechanical support would be used for the circulatory efforts.
The study was performed at the University hospital in Salt Lake City and followed the cardiac care of 123 patients between 2015 and 2018. The findings were compared with those of the 121 patients who were treated for the same illness right before the study began.
The results of the effort speak for themselves – the survival rate of refractory cardiogenic shock moved from 50% to 75%, a 50% increase. These results stayed the same whether the patient was treated in the hospital or was at home, and whether his case originated in the treating hospital or he came from a different hospital.
The researchers credited the team approach with the change. Having input from several directions to make the decision for each patient, as opposed to one physician, helps account for each factor in the patient’s care and allows for more controlled care and better results.The University has continued to use the shock team for its refractory cardiogenic shock patients, but larger studies need to be done to see if the same results can be sustained in different areas with different populations.
This investigation of study was published in the July issue of Circulation Magazine.
Sinai’s cardiac team helps cardiac patients after a heart attack with a comprehensive and effective cardiac rehab program.