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21. July 2005 06:53
       
   

 
  
       




    


    
 
 
   

 
 
  
 

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³Although patients with cardiogenic shock are critically ill, most of those who survive
their heart attack have good quality of life and physical functioning, and emergency
revascularization treatment was a predictor of outcome one year later,´ said Lynn A. Sleeper,
Sc.D., at the New England Research Institutes in Watertown, Mass. ³Cardiogenic shock appears
to be an acute systemic disturbance; that is, if the patient survives, the patient typically has good
functional status,´ said Dr. Sleeper, Sc.D.
Dr. Sleeper noted that this finding differs from what is typically seen in patients with
chronic heart failure.
About one of every dozen heart attack patients experiences cardiogenic shock. The heart
no longer pumps effectively, leading to a rapid drop in blood pressure and organ
failure. Cardiogenic shock is the leading cause of death for people admitted to the hospital with
a heart attack, with death ranges historically ranging between 60 percent and 70 percent.
This study analyzed the results of follow-up interviews with surviving participants in the
³SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK´ (SHOCK)
trial. The main trial enrolled cardiogenic shock patients from April 1993 to November 1998 at 30
international sites. The participants were randomly assigned to undergo emergency
revascularization (either coronary artery bypass graft surgery or angioplasty) to restore blood
flow to the heart muscle or to a control group treated with typical medical stabilization. Patients
in the control group had the option of later non-emergency procedures to reopen heart blood
vessels.
The SHOCK trial showed that emergency revascularization reduced the death rate at six
months to 51 percent. However, cardiogenic shock inflicts heavy damage to the heart, so
researchers wanted to know what sort of quality of life the survivors had.
The SHOCK trial survivors completed interviews at two weeks after discharge and at six
and 12 months after their heart attacks. Of the patients who survived at least one year, 87 percent
reported having either no symptoms or some symptoms, though with the ability to do normal
activities with only slight limitations. The overall amount of improvement during the time from
shortly after hospital discharge until one year later was similar in both the emergency
revascularization group and the group that was initially stabilized medically. However, the
patients who underwent the emergency bypass or angioplasty procedures were more likely to be
stable (71 percent vs. 44 percent) and less likely to worsen or die (15 percent vs. 34 percent) than
the patients who received initial medical stabilization.
³Although approximately half of these patients will die despite aggressive intervention
and many days in the intensive care unit, the outcome for survivors of that early period is very
rewarding,´ Dr. Sleeper said. ³The majority of cardiogenic shock survivors have very good
quality of life following their heart attack, and treatment with emergency revascularization plays
a role in preventing the deterioration of physical functioning.´
 However, early revascularization is generally available only in tertiary care centers,
accounting for about 15 percent of U.S. hospitals. Dr. Sleeper said that, in 2004, fewer than half
of cardiogenic shock patients received an early revascularization procedure.
Although this study was not designed to determine why patients fared better after
emergency revascularization, she suggested possible explanations.
³One hypothesis is that the patients treated with emergency revascularization do better
because the rapid treatment helps to save more of the heart muscle from destruction following
a heart attack,´ she said.
The treatment also interrupts the vicious spiral of ischemia (interrupted blood flow) in the
parts of the heart muscle served by the coronary arteries.
Dr. Sleeper pointed out that not all survivors were interviewed at all the time points indicated in
the study protocol; therefore, the findings may not be applicable to all survivors of cardiogenic
shock.
E. Magnus Ohman, M.D., F.A.C.C., at the University of North Carolina in Chapel Hill,
who co-authored an editorial in the journal with Patricia P. Chang, M.D., M.H.S., F.A.C.C.,
called the results of this study rewarding for clinicians.
³The main issue for me is that there¶s always been some concern that when you do early
revascularization for patients in cardiogenic shock, you might end up saving people to a pretty
horrible quality of life,´ Dr. Ohman said. ³What this study shows is that quality of life among the
survivors actually is pretty good.´
The American College of Cardiology, a 33,000-member nonprofit professional medical
society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease
prevention through professional education, promotion of research, leadership in the development
of standards and guidelines, and the formulation of health care policy.
http://www.acc.org
Aldren B. Gonzales
BSN-4A

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May be all patients admitted especially those who had emergency procedure has only one
wish ± to recover easily and live a good life after. As health care workers, we are one of many
factors yet the most important in achieving this goal. We have the responsibility to do our very
best in order for our patients to have a smooth surgery and prevent complications.
According to the article, about one of every dozen heart attack patients
experiences cardiogenic shock. In this case, the heart no longer pumps effectively, leading to a
rapid drop in blood pressure and organ failure. Cardiogenic shock is considered as the leading
cause of death for people admitted to the hospital with a heart attack, with death ranges
historically ranging between 60 percent and 70 percent. The study analyzed the results of follow-
up interviews with surviving participants in the ³SHould we emergently revascularize Occluded
Coronaries for cardiogenic shocK´ (SHOCK) trial. The main trial enrolled cardiogenic
shock patients from April 1993 to November 1998 at 30 international sites. The participants were
randomly assigned to undergo emergency revascularization (either coronary artery bypass graft
surgery or angioplasty) to restore blood flow to the heart muscle or to a control group treated
with typical medical stabilization. Patients in the control group had the option of later non-
emergency procedures to reopen heart blood vessels. The result showed that emergency
revascularization reduced the death rate at six months to 51 percent. However, cardiogenic
shock inflicts heavy damage to the heart, so researchers wanted to know what sort of quality of
life the survivors had.
The main issue for the situation is that there¶s always been some concern that when one
does early revascularization for patients in cardiogenic shock; it might end up saving people to a
pretty horrible quality of life according to Dr. Ohman. In that case, we should always have time
to really assess what our patients need. As nurses, we should provide our patients individualized
care in order to provide effective and efficient care.
As future registered nurses, we should also assess and try to give inputs to physicians, our
assessments and recommendations regarding our assessment. We should be knowledgeable to
whatever we do to our patients in order to give them quality patient outcome.