MedicalResearch.com Interview with:
Rashmee U. Shah, MD MS
University of Utah School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Shah: The purpose of this study was to evaluate long term outcomes of acute myocardial infarction (AMI) survivors who have cardiogenic shock. We used the ACTION Registry-GWTG (from the NCDR), which is the largest database of AMI, or heart attack, patients in the United States. Some heart attack patients develop cardiogenic shock which is a condition in which the heart muscle becomes so weak that it cannot effectively pump blood to the rest of the body. These patients are critically ill, but with advances in our treatment for heart attacks, many will survive to hospital discharge. We wanted to know, after all the intense treatment and sometimes long hospitalization, how do these patients fare when they leave the hospital? From a total of 112,668 heart attack patients who survived hospitalization, we identified 5,555 who had cardiogenic shock. Over half of all patients were either hospitalized or died within one year of discharge, and this poor outcome was more common among patients who had cardiogenic shock. In fact, the risk of death or hospitalization seems to be clustered in the early post-discharge time period, within 60 days, for patients with cardiogenic shock. After 60 days, shock and non-shock patients experience similar risk. In other words, we found that heart attack patients who had cardiogenic shock are particularly vulnerable during the first 60 days after hospital discharge.
Medical Research: What should clinicians and patients take away from your report?
Dr. Shah: The “take away” from our results is that patients can still be unwell after hospital discharge. Patient, families, and providers need to be aware that over half of these patients will experience an adverse event soon after discharge. This finding may prompt providers to be more attune to post-hospital care, including close follow up, physical therapy, and other support measures to help patients through a tough time period.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Shah: Now that we recognize this vulnerable time period, we need to test interventions to improve these outcomes. Thus far, our interventions and assessments focus on short term outcomes- in-hospital mortality and 30 day readmissions. We need to focus equally, if not more so, on long term outcomes. We should test the effects of in-hospital interventions, such as mechanical support devices (i.e. left ventricular assist devices), on long term outcomes. These devices may help patients survive the hospitalization, only to die or be re-hospitalized soon after. In addition, our evaluations need to incorporate patient-reported outcomes. The measures focus on actual day to day patient experiences, such as the ability to walk up a flight of stairs or walk around the block without feeling short of breath.
Medical Research: Is there anything else you would like to add?
Dr. Shah: We’ve provided prognostic information for a very sick group of patients. The inclination of providers, like myself, is to find lifesaving interventions we can use to help these patients. But we can’t forget that some patients may prefer symptom focused interventions, including hospice and palliative care. We have an obligation to equally and fairly discuss such options with our patients.
Rashmee U. Shah, MD MS (2016). Heart Attack Patients With Shock Particularly Vulnerable First 60 Days After Discharge