RESOURCES
According to the CDC, Arkansas ranks the 4th highest per capita of all states in heart disease mortality, behind only Mississippi, Oklahoma and Alabama.
Acute myocardial infarction (AMI) accounts for 81% of patients with cardiogenic shock (CS), and CS is the leading cause of death in sequel to AMI. Early revascularization in AMI has dramatically improved mortality, yet CS remains a common cause of mortality despite these advances in care. (Vahdatpour, et. al., Cardiogenic Shock, JAHA 2019; 8:e011991)
An extensive US National Inpatient Sample review revealed that hospitalizations attributed to CS have tripled from January 2004 to December 2018. However, there has been a slow decline in CS in-hospital mortality: from 1 in 2 in 2004 to about 1 in 3 in 2018. The clinical implications are that despite the currently available treatment strategies for CS, mortality among these patients continues to be substantial. (Osman, et al., Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States, JAHA 2021; 10:e021061)
It was postulated in 2015 that statewide networks for the management of AMICS could significantly impact mortality in AMICS, provided that they adopted guidelines to standardize the delivery of care better and adopt a structure similar to the Trauma Center “Golden Hour” paradigm. This systemized approach has demonstrated benefits nationally by quickly recognizing reversible causes that can be fixed, guiding prompt intervention, and providing for transfer to definitive care when the patient’s needs exceed local resources. (Massey, et al., Call for Organized Statewide Networks for Management of Acute Myocardial Infarction-Related Cardiogenic Shock, JAMA Surgery, November 2015 Volume 150, Number 11)
In the past few years, specially-formed networks, as described above, have created protocols of care for AMICS and documented significant achievements in reducing mortality. We believe this can be replicated in our state. To the best of their abilities, members of Arkansas Shock Network have agreed to adopt a standardized treatment protocol and network-based model that grants them the ability to collaborate, learn and escalate care (either in-house or via transfer) more uniformly.
