Amanda Wilde (Host): Welcome to MD Cast by Tampa General Hospital, a go-to listening location for specialized physician to physician content, and a valuable learning tool for world class healthcare. I'm Amanda Wilde, inviting you to join Dr. Debbie Rinde-Hoffman from Tampa General Hospital as we talk about the Cardiogenic Shock Program. Dr. Rinde-Hoffman is Vice Chief at Heart and Vascular Institute and Co-Director of the Cardiogenic Shock Program. Dr. Rinde-Hoffman, thank you so much for being here.

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: My pleasure. Thank you for having me.

Host: So we're going to talk about cardiogenic shock, how to spot it early and how you save lives and how to improve a multidisciplinary team. Let's start with what it is. What is cardiogenic shock?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: So cardiogenic shock is a clinical situation that occurs when the heart is no longer able to keep up with the metabolic demands the body has. Most commonly we think of cardiogenic shock in the face of somebody having a massive heart attack, but can also occur as somebody has been living with a weakened heart muscle, and over time the heart just is unable to keep up any longer.

Host: What are the symptoms of cardiogenic shock?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: The symptoms include shortness of breath, low blood pressure, and the inability for the organs to get well perfused, so patients become cold, clammy. They don't urinate well, they get short of breath and their blood pressure is low.

Host: That I assume would be considered an emergency. Should someone experiencing these symptoms take themselves to the emergency room? What happens when people experience cardiogenic shock?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: That would be 911. And yes it is a true emergency because we can intervene earlier and save lives. And the early intervention is really at the forefront of what allows patients to recover from their episode of cardiogenic shock, or if their heart is just unable to recover, we are able to offer other therapies like heart transplant or the implantation of a ventricular assist device so that patients can continue living quality lives.

Host: Tell me more about the Cardiogenic Shock Program. It's obviously focused on people with this particular condition.

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: So our cardiogenic shock program has been formalized in February of 2022. And even though at Tampa General, we've been doing all kinds of advanced cardiac work for the last 30 plus years, with the formalization of this program, we have been able to recognize the insidious onset of patients in cardiogenic shock and the acute onset of patients with cardiogenic shock.

And what our strength is that once a patient is recognized, we have a multidisciplinary phone call so that we get four physicians at least, from different specialties meaning a cardiac surgeon, a cardiac intensivist, that's a doctor that works in the cardiac ICUs, a heart failure specialist and an interventional cardiologist all on the phone within four minutes to discuss the case, decide what the best treatment option is, and to make it all happen.

That can't happen without the champion physicians that are willing to dedicate themselves to taking these calls at all hours of the day or night and a hospital system that's really supportive of world class care.

Host: So how do you get buy-in from the administration for the cardiogenic shock program?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: Well, I think we get buy-in because we really want to be at the cutting edge. We really want to stand out as a differentiator as how we can do things at Tampa General that not necessarily is able to be done with the same degree of proficiency at other hospitals that may not have the modalities available to them.

So in those situations, a little bit of an aside, we also have the ability to have other hospitals call us with their patients, talk to us about their patients. We have the same type of multidisciplinary discussion, and if we have to send a helicopter to bring them to Tampa General so that we can take care of them, we do that.

So I think it's a great service to the community to be able to offer this type of cutting edge care.

Host: Absolutely. And how do you educate the population within the hospital to enhance the effectiveness of this program?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: Lots of dog and pony shows. So we have spoken to the emergency room, we have spoken to the hospitalist groups, we've spoken to all of the cardiologists, we've spoken to all of the intensive care unit physicians multiple times because repetition is the best way to solidify knowledge.

We have flyers up all over the hospital to say if you have a patient who has hypotension, meaning low blood pressure, heart failure, which means they're short of breath and hypoperfusion, which means that they're not perfusing their organs; think about cardiogenic shock and there's a single phone number to call throughout the entire hospital, and then the operator gets the whole gang on the phone, like I said, within a four minute period.

Host: So you obviously have improved outcomes with your multidisciplinary team and that enhanced accessibility and education within and without of the institution. What has been the impact of the program over the past three years?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: Well, I think you hit the nail on the head. We have saved more lives. We have improved survivals with patients who have cardiogenic shock. So cardiogenic shock is also along the continuum. So somebody can have this is going to sound a little funny, but mild cardiogenic shock, moderate cardiogenic shock, and severe cardiogenic shock.

All of those have different historic survival rates. But if one comes to Tampa General and has moderate cardiogenic shock, their survival rate is in excess of 90%. Historically, those survivals have been less than 50%. If you come in with pretty severe cardiogenic shock, where those typical survivals are in the 25 to 30% range; with our program, we've improved those survivals from anywhere to 50 to 65%.

So we have saved in excess of 300 lives since we've started this program and really have given lots of patients, lots of second chances.

Host: That is such an impressive list of accomplishments. As you look toward the future, how do you want to see the program evolve?

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: So my personal dream is to try to have every patient who lives in our catchment area be able to partake in this program. We'd like to see, doesn't matter where you end up, at whatever hospital system you end up at, that all of the care for the patients in Hillsborough County and surrounding counties are all of the same level so that we can impact and save even more lives.

Host: Dr. Rinde-Hoffman, thank you so much for walking us through what is cardiogenic shock, how to spot it early, and how and why shock teams save lives.

Debbie Rinde-Hoffman, MD, FACC, FACP, FHFSA: Thank you very much for the opportunity and hope we can continue to grow.

Host: That was Dr. Debbie Rinde-Hoffman. She is Vice Chief at Heart and Vascular Institute and Co-Director of the Cardiogenic Shock Program. Visit our Defining Medicine website where you will find links to journal publications, clinical trials, podcasts, and CMEs, physician profiles and more.

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