Despite the many advances in clinical care for the treatment of acute myocardial infarction (MI) and heart failure (HF), cardiogenic shock (CS) survival remains unchanged at 40%. For MI patients alone, the 30-day mortality rate is 40-50%, and it has remained at this level for the last two decades.
Building upon the established acceptance that there are varying degrees of CS, the Society for Cardiovascular Angiography and Interventions convened a group of experts with the express purpose of establishing a more accurate classification of the different phases of the CS spectrum. In doing so, these experts aimed to move closer to a tool that could better guide treatment and predict outcomes.
Baylor Scott & White Health’s Shelley Hall, MD, FACC, FHFSA, FAST, was among those asked to join this collaboration, which also included other representatives from cardiology (interventional, advanced heart failure and noninvasive), emergency medicine, critical care, and cardiac nursing. “A large part of the challenge in advancing this field is the wide range of how we have defined shock in various trials resulting in largely neutral results and inability to apply to the general patient population,” explains Dr. Hall.
A Clinical Consensus Statement around the group’s proposed CS classification, endorsed by the American College of Cardiology, American Heart Association, the Society of Critical Care Medicine, and the Society of Thoracic Surgeons, was recently published in Catheterization & Cardiovascular Interventions.
The system presented by the authors sets a classification spectrum ranging from “A”—denoting patients generally at risk for CS—to “E”—denoting patients who are highly unstable, often with cardiovascular collapse. The schema is designed with simplicity in mind to establish a common language for the field. Most importantly, the authors believe this simple schema is applicable across the care spectrum, creating a truly universal “lingua franca” that “supports communication at the bedside, in the catheterization laboratory, at the level of shock teams across institutions and with clinical trialists as new approaches are tested to reduce the high mortality of CS.”
The full paper as published in Catheterization & Cardiovascular Interventions can be found here.