Clinician improving the odds for critically ill patients in Calgary

Cardiogenic shock is a life-threatening emergency that happens when the heart can’t pump enough blood and oxygen to keep the body functioning. 

The most common cause of this condition is a heart attack and up to eight per cent of patients hospitalized with an emergent heart attack end up in cardiogenic shock. 

Although there are treatments for this condition, globally, almost half of those who suffer from cardiogenic shock while in the hospital will die from the condition. 

Dr. Ayaaz K. Sachedina, an interventional cardiologist who specializes in advanced life support and leads the Percutaneous Mechanical Support Program in the Cardiac Catherization Lab at the Foothills Medical Centre (FMC), is trying to improve the odds for patients. He’s been busy since arriving in Calgary in September 2020. 

Armed with the evidence that time is of the essence in improving survival rates, Sachedina led the initiative to create the Calgary Cardiogenic Shock Team in early 2022. Implemented in the cardiac catheterization (cath) lab and the Cardiac Intensive Care Unit at FMC, it’s the first of its kind in the city.

The Calgary Cardiogenic Shock Team is made up of a group of physicians representing several subspecialties, such as interventional cardiology, cardiac surgery and advanced heart failure. 

Available within minutes, these professionals collectively make decisions about how to best treat individual cardiogenic shock patients, whether by using drug therapies or other interventions such as placing them on advanced mechanical life support. 

In many instances, utilization of the cardiogenic shock team has reduced decision-making time significantly when treating emergent patients. The relevant specialists are often aware of the patient and involved in their care within minutes of the team’s activation. 

“Shared decision-making, based on an individual patient’s needs, is critical to improve mortality rates and outcomes in these patients,” says Sachedina. 

Dr. Vikas Kuriachan, MD, the academic and clinical head of the Department of Cardiac Sciences at the Cumming School of Medicine, says fostering a team-based approach in caring for patients is an important goal of the Department. 

“Cardiac care is very complex and almost always involves different specialists and allied health care providers to obtain optimal outcomes, so a team-based approach is necessary to provide the best care to our patients,” says Kuriachan. “When it comes to cardiogenic shock, early identification and management of these patients has important implications for patient outcomes, making a multidisciplinary approach extremely important.”

Patient tracking

According to Sachedina, historically it wasn’t common to track data on cardiogenic shock patients in the cath lab —including the number of patients and their survival rate. This lack of data makes it challenging to conduct research or improve processes to optimize care and survival rates.  

Sachedina wants to change that. 

He has started a province-wide collaboration of cath labs with the goal of tracking every Albertan who experiences cardiogenic shock in a cath lab setting. He is hoping to expand his efforts to include a province-wide registry of all patients, both in and out of the cath lab, in hopes that the data will drive future research efforts. 

Kuriachan applauds efforts to collect information on this patient population. 

“Registries are an important tool for gathering information on the actual management of patients and assessing outcomes in the real world,” he says.  

Education Initiatives

Sachedina also founded the Calgary Shock Symposium (CathSHOCK) in 2022. The multi-disciplinary conference, which focuses on managing shock in the cath lab, is the only conference of its kind in Canada. It features expert presentations and hands-on simulations geared towards physicians and other health care professionals who care for cardiogenic shock patients, who are considered the sickest of the sick. 

Sachedina says feedback has been positive. 

“There is definitely interest from across the country,” he says, adding the Canadian Association of Interventional Cardiology, the Houston Shock Symposium and the Canadian Council of Cardiovascular Nurses are now partners.

“We are hoping to continue to grow this symposium and hopefully change the conversation on cardiogenic shock in Canada.” 

For more information on CathSHOCK, visit www.cathshock.com

Dr. Ayaaz K. Sachedina is clinical assistant professor in the Department of Cardiac Sciences at the University of Calgary’s Cumming School of Medicine. He leads the Percutaneous Mechanical Circulatory Support Program for the cardiac catheterization lab at Foothills Medical Centre and is the incoming program director for the Interventional Cardiology Fellowship program. He is a member of the Libin Cardiovascular Institute. 

Dr. Vikas Kuriachan, MD, is the academic and clinical head of the Department of Cardiac Sciences at the University of Calgary’s Cumming School of Medicine. Professor Kuriachan is a cardiologist and cardiac electrophysiologist and a member of the Libin Cardiovascular Institute.