{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:35:36Z","timestamp":1792726536795,"version":"4.5.0"},"reference-count":16,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high mortality. Early revascularisation improves survival, but the effect of structured multidisciplinary care on outcomes remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>ACT-SHOCK is a service evaluation at a UK tertiary cardiac centre. Between May 2023 and May 2024, 82 patients with AMI-related CS requiring emergent percutaneous coronary intervention (PCI) were identified using protocolised physiological criteria and managed by an Advanced Cardiogenic-Shock Team (ACT). The ACT comprised interventional cardiologists, intensivists, anaesthetists, critical care staff and cardiac physiologists, coordinating PCI and ongoing care. Outcomes were compared with 83 historical controls from the year preceding ACT roll-out, who received standard care without ACT activation. Primary endpoints were 30-day and 1-year all-cause mortality; secondary outcomes included predictors of 30-day mortality.<\/jats:p>\n                    <jats:p>Within the ACT cohort, elevated lactate, critical care admission, invasive ventilation, out-of-hospital cardiac arrest and Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage E at first medical contact predicted 1-year mortality. Adjusted analyses showed ACT management was associated with lower 1-year mortality compared with standard care (HR 0.53, 95%\u2009CI 0.30 to 0.92; p=0.026). Although 30-day mortality was lower in the ACT group, this did not reach statistical significance (HR 0.71, 95%\u2009CI 0.39 to 1.29; p=0.26). Escalation from coronary care to critical care during the recovery phase occurred more promptly in the ACT group (9.7% vs 2.4%, p=0.09). At 24 hours, a smaller proportion of ACT patients remained in SCAI stages D\/E compared with standard care (42% vs 48%; p=0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of physiological criteria to identify CS and activation of a multidisciplinary ACT in a UK tertiary centre was associated with earlier detection and improved 1-year survival in AMI-related CS. These pilot data support further study across multiple UK centres to inform national policy and standardise care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003794","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:35:23Z","timestamp":1769171723000},"page":"e003794","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Advanced Cardiogenic-shock Team versus standard care in cardiogenic SHOCK: a single centre service evaluation project"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1299-0358","authenticated-orcid":false,"given":"Nitin","family":"Chandra Mohan","sequence":"first","affiliation":[{"name":"Translation Health Sciences, University of Bristol, Bristol, UK"},{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Govier","sequence":"additional","affiliation":[{"name":"Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W","family":"Johnson","sequence":"additional","affiliation":[{"name":"Translation Health Sciences, University of Bristol, Bristol, UK"},{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Felekos","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Richards","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Strange","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amardeep","family":"Dastidar","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Novalia","family":"Sidik","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Dorman","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Joshi","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Gurney","sequence":"additional","affiliation":[{"name":"Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Bourdeaux","sequence":"additional","affiliation":[{"name":"Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Grant","sequence":"additional","affiliation":[{"name":"Anaesthetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Oglesby","sequence":"additional","affiliation":[{"name":"Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"McInerney-Baker","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sodiq","family":"Yaya","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Keeble","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK"},{"name":"School of Medicine and MTRC, Anglia Ruskin University Faculty of Medical Science, Chelmsford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh","family":"Pareek","sequence":"additional","affiliation":[{"name":"Cardiology, King\u2019s College Hospital NHS Foundation Trust, London, UK"},{"name":"School of Cardiovascular and Metabolic Medicine & Sciences, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Rees","sequence":"additional","affiliation":[{"name":"Cardiology, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-7829","authenticated-orcid":false,"given":"Nick","family":"Curzen","sequence":"additional","affiliation":[{"name":"University of Southampton Faculty of Medicine, Southampton, UK"},{"name":"Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Mariathas","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"2026012304351170000_13.1.e003794.1","first-page":"29","article-title":"SCAI clinical expert consensus statement on the classification of cardiogenic shock","volume":"94","author":"Baran","year":"2019","journal-title":"Cathet Cardio Intervent"},{"key":"2026012304351170000_13.1.e003794.2","first-page":"676","article-title":"Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock","volume":"124","author":"Basir","year":"2019","journal-title":"Am J 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Cardiac arrest during cardiology procedures requiring anaesthesia. In: NAP7: cardiac arrest under anaesthesia. London: Royal College of Anaesthetists, 2023: 373\u201382."},{"key":"2026012304351170000_13.1.e003794.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(19)32265-X"},{"key":"2026012304351170000_13.1.e003794.10","first-page":"821","article-title":"Multidisciplinary cardiogenic shock team approach improves the long-term outcomes of patients suffering from refractory cardiogenic shock treated with short-term mechanical circulatory support","volume":"12","author":"H\u00e9rion","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026012304351170000_13.1.e003794.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.07.044"},{"key":"2026012304351170000_13.1.e003794.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.09.005"},{"key":"2026012304351170000_13.1.e003794.13","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.123.031979","article-title":"Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices","volume":"13","author":"Senman","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026012304351170000_13.1.e003794.14","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ahj.2020.10.054","article-title":"Shock in the cardiac intensive care unit: Changes in epidemiology and prognosis over time","volume":"232","author":"Jentzer","year":"2021","journal-title":"Am Heart J"},{"key":"2026012304351170000_13.1.e003794.15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijcard.2022.08.043","article-title":"Cardiogenic shock\u2013related cardiovascular disease mortality trends in the US population","volume":"367","author":"Ghajar","year":"2022","journal-title":"Int J Cardiol"},{"key":"2026012304351170000_13.1.e003794.16","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1016\/j.jacc.2025.03.003","article-title":"Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial","volume":"85","author":"Morici","year":"2025","journal-title":"J Am Coll Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003794","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:35:24Z","timestamp":1769171724000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,23]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003794"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003794","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}