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 3
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.
This article continues the series (Part 1 and Part 2) by outlining how the UPMC Cardiogenic Shock Program evolved into a coordinated, systemwide model and how care extends beyond the acute phase of cardiogenic shock.
Moving Toward a Coordinated, Multidisciplinary Program (2020–2025)
The early iteration of the cardiogenic shock program faced its first major test in 2020 with the onset of the COVID-19 pandemic. Capacity constraints, surges in critically ill patients, and other factors forced rapid adaptation. These pressures accelerated the need for standardized pathways, transparent triage, and real-time communication.
The Impella 5.5 with SmartAssist is an FDA-approved, temporary, surgically inserted micro-axial ventricular support device that delivers up to 5.5 L/min of blood flow. It acts as a bridge to recovery, ventricular assist device, or transplant by unloading the left ventricle, reducing its workload, and providing circulatory support in patients with severe heart failure or cardiogenic shock. In 2021, the increased programmatic use of this device and standardization of care has shown to decrease mortality, increase native heart survival, and continue to bridge patients to advanced therapies such as VAD and transplant.
By 2022, the program began to extend outward. Outreach efforts intensified, a Recognition Team process was formalized, referring follow-up was established, and educational resources were developed and posted to the UPMC Heart and Vascular Institute website. Data collection and outcomes tracking became integral components of how the program efficacy is measured.
In 2023, governance structures were introduced. A Steering Committee was formed, shock outreach workshops were launched, and dedicated clinical pathways or treatment algorithms for acute myocardial infarction and heart failure generated cardiogenic shock were established. Intake notes standardized documentation processes, and quarterly patient reviews created structured feedback loops to help the team improve the function of the cardiogenic shock program over time.
By 2024, the program’s learning infrastructure matured. Impella interrogation billing and device-level outcomes tracking were implemented. Recovery data and internal catheterization lab activation processes were incorporated. Observed/expected reports, a Clinical Quality Council review was established, and tracking of futile cases and nontransfers strengthened accountability.
In 2025, the cardiogenic shock program entered a new phase of growth. Order sets were integrated across electronic health record systems. Patient selection guidelines for Impella 5.5, weaning protocols, transport checklists, and reposition training were standardized. Multicenter morbidity and mortality reviews, the Cardiogenic Shock Survivor Clinic, and high-risk PCI hemodynamic optimization were all implemented as part of the program’s ongoing evolution.
“Way back in the beginning we thought the team was just a small group of physicians on a call, but it became obvious that five doctors is not a functional shock program by itself. You need the bed and staffing infrastructure, the nurse leadership, and transport that can assess patients at the bedside and move them to the right facility with communication across the entire chain,” Dr. Hickey says.
The cardiogenic shock program that has been created by the UPMC Heart and Vascular Institute is not defined by a single unit, specialty, or technology. It functions as a network of clinicians, hospitals, and care environments operating under a shared model of recognition, communication, and escalation.
“Once patients are identified, having order sets, algorithms, and standards of care matters whether they are transferred or managed at a tiered center. We have been rolling those tools out beyond a single site, and the goal is to broaden standardization as we continue expanding across the system,” Ms. Kunz says.
Making the Program Work Over Time: Education Is the Foundation
The entire program – none of it would be possible or exist in its present form without the extensive educational efforts and outreach across the UPMC system and into the community. The goal was to ensure that cardiogenic shock was recognized earlier, described consistently, and understood as a dynamic process rather than an end-stage event. By everyone, no matter where they might be.
“We realized very quickly that a fully functioning, multidisciplinary cardiogenic shock program was not going to work if the only people who understood the process were at the tertiary center. Most of these patients are first seen somewhere else, and by the time the call comes in, we are already behind,” Ms. Kunz says. “Education became the foundation of our program. Everyone had to know what cardiogenic shock looks like early, what information needs to be gathered, and how to communicate severity and trajectory. Once we aligned around that, everything else from activation of the shock program, patient transport, bed placement, and team response could finally move fast enough to matter.”
This educational effort was multidisciplinary and systemwide. Cardiologists, cardiothoracic surgeons, intensivists, emergency clinicians, advanced practice providers, nurses, and transport teams were taught to identify cardiogenic shock using common definitions and to communicate severity using the same staged framework.
“In addition to building internal communication, we had to educate externally and repeatedly. Once the process started working, the next step was telling referring teams, ‘identify shock early, call us early, and transfer patients as soon as possible,’ and we iterated on how we communicate that for years,” Dr. Hickey says. “We’ve never stopped, nor can we. The educational work that Nicole and the rest of the team has done in service to informing and promoting what the program is, how it functions, and how every touch point needs to be aligned for it to work is the reason it works and why we’ve been able to meaningfully decrease mortality within our system.”
Part of scaling education was the recognition by the team that physician outreach is not enough. Building nursing champions at outside hospitals strengthens recognition and coordination at the point of first contact.
“When I speak with other centers about their shock teams, a common challenge is implementation. What made this possible here was early buy-in and culture change across interventional cardiology, surgery, critical care, and the cardiac ICU. There was shared agreement that building a coordinated, protocolized team was necessary to improve survival,” Dr. Hickey says. “But, without the education piece and the community work, it doesn’t work.”
Longitudinal Model of Care
Caring for patients with cardiogenic shock who survive does not end when they are discharged from the hospital. Many patients experience prolonged recovery and require coordinated follow-up across specialties. Because of this dynamic, the UPMC Heart and Vascular Institute Cardiogenic Shock Program works on a longitudinal perspective because cardiogenic shock is a condition with lasting physiological and psychosocial consequences. Education and care coordination extend into the post discharge period to reinforce and provide continuity of care. Recovery from cardiogenic shock is an ongoing process and not one with a fixed timeframe or endpoint.
“For many patients, cardiogenic shock is the first time they have ever had to navigate the medical system, and survival is only the first step. After discharge, they may be dealing with medications, follow-up logistics, insurance and financial stress, and psychological sequelae, and the clinic is built to help patients stay connected to cardiac care and address those barriers,” Ms. Hopwood-Brophy says.
One of the most recent outgrowths of the program in 2025 was the creation of a formal Cardiogenic Shock Survivor clinic. The clinic is run by Ms. Hopwood-Brophy and is designed to address the long-term care needs for patients.
Typically, this is going to involve the need for cardiac rehabilitation, coming to terms with and working through the psychosocial and mental stress aspects of having survived cardiogenic shock, and various resources in the community that can help support patients through a lengthy recovery process.
“We’re talking about time away from work and medical bills and how to deal with that dynamic, what the recovery process may look like, medication management, and a lot more,” Ms. Hopwood-Brophy says. “For a lot of these patients there’s a risk for another occurrence of cardiogenic shock, so how can we work toward avoiding that scenario.”
What’s Next for the Cardiogenic Shock Program at UPMC?
From recognizing cardiogenic shock as a systems problem, to leveraging new shared definitions and staging for the condition and building a program based in education and multidisciplinary alignment, the UPMC Heart and Vascular Institute has created a new model of cohesive care for cardiogenic shock. By ensuring that providers and care teams everywhere understand what cardiogenic shock looks like, that is recognized earlier, described consistently, and managed collaboratively, the program is working to overcome many of the root causes that make mortality so high in this patient population.
The work of redefining cardiogenic shock, aligning around a shared framework, and embedding education across disciplines has fundamentally changed how this syndrome is recognized and managed within UPMC and UPMC Heart and Vascular Institute, and the medical community at large. Recognition does not begin in the catheterization lab, the ICU, or even the emergency department of a tertiary center. For many patients, the first opportunity to alter the trajectory of cardiogenic shock occurs hours earlier, in community hospitals, ambulances, and emergency settings where the syndrome is most likely to be missed. If education is the key, its greatest accomplishment is reaching clinicians at the point of first contact with the patient.
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