Creating a Team-Based, Education-Centric Program To Manage Cardiogenic Shock: UPMC Heart and Vascular Institute’s Multiyear, Multidisciplinary Approach to Improve Mortality and Long-Term Patient Outcomes – Part 1
April 24, 2026
Featured in this three-part article series are:
- Gavin Hickey, MD, medical director, Cardiogenic Shock Program, medical director, VAD and Transplant Program, UPMC Heart and Vascular Institute Cardiogenic Shock Program
- Nicole Kunz, RN, nurse manager, Artificial Heart and Cardiogenic Shock Program, UPMC Heart and Vascular Institute
- Amanda Hopwood-Brophy, PA-C, APP surgical supervisor, VAD and Transplant Program, UPMC Heart and Vascular Institute
Historically: 40 to 50% mortality. That ought to communicate precisely the gravitational force of cardiogenic shock on individuals that develop the syndrome. Not quite as all-consuming of what gets close to it as is a cosmic supermassive black hole, but much too high for any clinician, team, or hospital to accept as a given.
Within the UPMC Heart and Vascular Institute Cardiogenic Shock Program, current mortality is now closer to 25% following systemwide changes in how cardiogenic shock is recognized and cared for. This shift did not result from a single device or protocol, but from a coordinated, education-driven model built and refined over multiple years that treats cardiogenic shock as a time-dependent, progressive syndrome that mandates an early, coordinated, aggressive multidisciplinary response if patients are to survive.
Understanding why this shift has been possible requires first understanding what cardiogenic shock is at a physiologic level and why its progression and mortality has been so difficult to change.
Defining Cardiogenic Shock and Its Clinical Consequences
Cardiogenic shock is a state in which the heart is unable to circulate enough blood at thresholds required to sustain the usual metabolic demands of the body. This leads to a state of systemic hypoperfusion and progressive end-organ dysfunction. Body parts simply are not getting enough circulation to keep performing well enough to, in the long run, stay alive. Patients in a state of cardiogenic shock may present with pulmonary edema, worsening renal function, hepatic congestion, metabolic acidosis, and changes in mental status, and other symptoms, none of which are desirable.
Even with all the advances in reperfusion therapy, critical care, and mechanical circulatory support of the years, mortality has remained stubbornly high. It is difficult to outrun the gravity of a black hole when you are not sure what it is, what it can do, or if you can actually detect it outright.
The clinical presentation of cardiogenic shock is, like many conditions, one of heterogeneity. Some patients develop cardiogenic shock from an acute myocardial infarction, long thought to be the driver of the vast majority of cases. However, chronic or newly recognized heart failure, malignant arrhythmias, myocarditis, and other conditions are now known to be large contributors to the population of people diagnosed with cardiogenic shock.
“Cardiogenic shock has remained one of the most lethal conditions we treat, and for a long time we were seeing the same pattern over and over again. Patients were being identified too late, often after they already had significant end-organ failure,” Dr. Hickey says. “We were having conversations about devices and escalation when the physiology was already far advanced, and at that point, our ability to change the trajectory was limited or futile. The problem was not necessarily that we did not have therapies. The problem was that we did not have a consistent way to define cardiogenic shock, recognize it early, or communicate severity and trajectory across teams and hospitals. Without a shared language and a coordinated system, care was fragmented, timing of that care was inconsistent, and outcomes did not change in a meaningful way.
Until we treated cardiogenic shock as a progressive syndrome that required early identification, multidisciplinary decision making, and system-level coordination, we would always be reacting to the disease instead of optimally managing it.”
To change this trajectory, UPMC Heart and Vascular Institute created a Cardiogenic Shock Program with a dedicated team of experts to triage patients quickly and efficiently, and to work with providers internal and external to the UPMC system to develop an optimal treatment plan for each patient.
The UPMC Cardiogenic Shock Program, through a multidisciplinary approach is designed to aid in rapid identification of cardiogenic shock, implement and standardize hemodynamic monitoring and treatment for patients, limit the use of vasopressor and inotropes, instigate early use of mechanical support when dictated by patient needs, and assess patients for cardiac recovery or evaluate them for advanced supportive therapies.
However, to get to the point of a formalized, well-organized, efficient, and scalable program across multiple hospitals and geographies that could meaningfully impact patient outcomes, it involved a multi-year project requiring the expertise of many disciplines, buy-in from institutional leadership, and a rigorous, ongoing focus on education, standardized care pathways, and evolutionary adaptation of the program grounded in evidence-based medicine.
“The challenge is not just identifying cardiogenic shock but making sure that recognition leads to the same response across different teams and hospitals. That requires alignment in how people communicate, how they escalate care, and how they apply the process in real time,” Ms. Kunz says.
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