IMPLEMENTATION OF STANDARDIZED SCREENING OF CARDIOGENIC SHOCK (CS) FOR ALL PATIENTS ADMITTED TO THE CCU AT THE NEW BRUNSWICK HEART CENTRE

Abstract

BACKGROUND The management of cardiogenic shock (CS) remains challenging and is often associated with a high mortality. In an effort to better manage CS, we implemented a multidisciplinary “Shock Team” approach. As part of this effort, all patients admitted to the coronary care unit (CCU) were screened for CS using the Society for Cardiovascular Angiography and Interventions (SCAI) classification. The aim of the study was to 1) determine the feasibility of CS screening, and, 2) characterize the incidence and severity of CS in our CCU. METHODS AND RESULTS All patients admitted to the CCU at our centre over an 11-month period were included. The SCAI classification was used to categorize patients into “at- risk” (stages A-B) and “CS” groups (stages C- E). Screening for CS was to be performed on every patient every 12hr while in CCU by the patient's nurse. Activation of the Shock Team was made at the discretion of the CCU attending, and consisted of immediate communication between the CCU attending, interventional cardiologist and cardiac surgeon on call. During the initial 11-month period, 85% (1202/1419) of patients admitted to CCU were screened according to the SCAI classifications. Screening failures were not uniform throughout the study period, with a few months showing more screening failures (Figure 1). The majority of patients screened were in the at- risk group (91.8%; A-B), while 8.2% were in the CS group (C = 84 (7%), D = 7 (0.58%) and E = 11 (0.92%)). Patients in the CS group were younger (66 ± 13 vs. 68 ± 12 years; p=0.047), experienced higher in-hospital mortality (24% vs. 3.7%, p< 0.0001), and were more likely to be discharged to another facility rather than home (65% vs 25%; p < 0.001), compared to at risk patients. CONCLUSION Our study demonstrates that standardized screening for CS by nursing is feasible, though ongoing education is required to minimize screening failures. Cardiogenic shock is frequently diagnosed in patients admitted to our CCU and is associated with a high mortality. Further study is required to determine if systematic SCAI classification screening can facilitate early diagnosis of cardiogenic shock, shock team activation, and improve outcomes in this patient population. The management of cardiogenic shock (CS) remains challenging and is often associated with a high mortality. In an effort to better manage CS, we implemented a multidisciplinary “Shock Team” approach. As part of this effort, all patients admitted to the coronary care unit (CCU) were screened for CS using the Society for Cardiovascular Angiography and Interventions (SCAI) classification. The aim of the study was to 1) determine the feasibility of CS screening, and, 2) characterize the incidence and severity of CS in our CCU. All patients admitted to the CCU at our centre over an 11-month period were included. The SCAI classification was used to categorize patients into “at- risk” (stages A-B) and “CS” groups (stages C- E). Screening for CS was to be performed on every patient every 12hr while in CCU by the patient's nurse. Activation of the Shock Team was made at the discretion of the CCU attending, and consisted of immediate communication between the CCU attending, interventional cardiologist and cardiac surgeon on call. During the initial 11-month period, 85% (1202/1419) of patients admitted to CCU were screened according to the SCAI classifications. Screening failures were not uniform throughout the study period, with a few months showing more screening failures (Figure 1). The majority of patients screened were in the at- risk group (91.8%; A-B), while 8.2% were in the CS group (C = 84 (7%), D = 7 (0.58%) and E = 11 (0.92%)). Patients in the CS group were younger (66 ± 13 vs. 68 ± 12 years; p=0.047), experienced higher in-hospital mortality (24% vs. 3.7%, p< 0.0001), and were more likely to be discharged to another facility rather than home (65% vs 25%; p < 0.001), compared to at risk patients. Our study demonstrates that standardized screening for CS by nursing is feasible, though ongoing education is required to minimize screening failures. Cardiogenic shock is frequently diagnosed in patients admitted to our CCU and is associated with a high mortality. Further study is required to determine if systematic SCAI classification screening can facilitate early diagnosis of cardiogenic shock, shock team activation, and improve outcomes in this patient population.