University of Utah doctors discover potentially lifesaving treatment for cardiac patients

SALT LAKE CITY — Tracy Phillips wants to be able to go outside and fish again.

Phillips and his wife, Myrna, moved to Salt Lake City from Albuquerque, New Mexico, about four years ago so he could receive treatment from a team of University of Utah doctors for chronic heart failure.

"During that time, it's been a lot of procedures, a lot of tests, and that's been my hobby for the last four years — trying to get healthy," Phillips explained.

Jeffrey D. Allred, Deseret News

On July 1, while at the hospital for a clinical visit, doctors discovered he was in cardiogenic shock, which occurs when someone's heart can't pump enough blood and oxygen to the brain and other vital organs, according to the National Heart, Lung and Blood Institute.

When someone goes into cardiogenic shock after a heart attack or other medical condition, they have a 50 percent chance of dying. But U. doctors say they've discovered a way to improve those patients' chances of survival.

Cardiogenic shock, also known as cardiac shock, affects between 7% and 8% of heart attack patients, said Dr. Stavros Drakos, medical director of the U. Cardiac Mechanical Support Program and director of Cardiovascular Research for the Division of Cardiology.

"We have not been able to bring better results for decades and decades," Drakos explained.

But in 2015, U. doctors tried a new way that had been talked about but never done. During a study that was recently published in Circulation, university heart doctors developed what they call a "shock team" of specialists who work together to make decisions for cardiogenic shock patients' care from the onset.

Phillips said his doctor in New Mexico referred him to the Utah hospital because of the team.

"Fortunately, he put his pride to the side and informed me that he did not know what to do to help me, and that he had a good friend on the staff up here that could help me," Phillips recalled. Due to "great people" the couple met in Utah, they eventually bought a home here.

Now, he is waiting in the hospital until he can receive a heart transplant. He doesn't know when it might happen, but when it does, Phillips says he looks forward to "just get outside, to movement … I look forward to that."

Other conditions like chronic heart failure or complications after surgeries also often end in cardiogenic shock, Drakos said, making the condition a "major unmet need."

Jeffrey D. Allred, Deseret News

Before the study, the creation of intensive care units many years ago improved outcomes, but not much progress had been made in recent years, said Drakos, who served as the study's senior author.

"Things were tested, but they didn't work. So what we were testing here is a multidisciplinary approach. A team of specialists getting quickly together to put their minds together on how to better deal with these complex situations which have high mortality," Drakos said.

When he and others presented the rationale behind the study years ago, he said, some people thought there would be "too many cooks" in the kitchen, so to speak. Some expressed concerns that there would be disagreements and too many opinions for such a team to work effectively, Drakos said.

However, "the results were, I would say, excellent."

The researchers compared 121 cardiogenic shock patients before the study was launched, to 123 patients who received treatment from the shock team. The team included a heart failure cardiologist, a cardiothoracic surgeon, an interventional cardiologist and an intensive care unit physician.

Patients seen by the shock team had a 75% chance of survival at 30 days compared to a 50% survival rate for those treated before the team started.

Before the study, one doctor would usually make decisions for a patient's treatment, Drakos said.

Though upfront costs of having more physicians involved were more, those physicians would end up getting involved "down the road" anyway, but as more complications arose.

"When things get worse and worse, then, often, you will get people from these specialties that are mentioned involved. However, you will get them involved to help you resolve another complication, or another issue, as opposed to getting them from the get-go," Drakos said.

Jeffrey D. Allred, Deseret News

Megan Cottle, a patient in the intensive care unit, said having multiple doctors have a say in decisions about her treatment is comforting.

"They all come together with their brains and their knowledge, and they're trying to figure out what's best for me and my situation. And of course, they bring me options. It's not just like, 'We're doing this, we're doing this.' But I just like it because there's more than one mind working on it and helping to try to get me to a better place," Cottle explained.

A mother of two young daughters, she also awaits a heart transplant, noting that she looks forward to "little things."

"My girls, I haven't been able to do a lot with them. So even just being admitted, they're like, 'Oh, Mommy will get a new heart, we can go on walks and she won't get tired quick and go for bike rides.' Just little things like that and so I'm excited. Nothing, like it's grand to me, but nothing like huge," Cottle said. "But just being able to walk without getting tired and short of breath."

After the proof-of-concept study's completion in 2018, the hospital is continuing to use its shock team as of late July.

"We feel that the evidence is good enough to implement it, in the absence of other evidence," Drakos said, adding that if trials "disprove" the results in the future, the hospital will reconsider. But the doctors found that it works in their facility.

While nurses didn't get mentioned in the "Circulation" paper, they served as a crucial member of the team, Drakos said. "If you ask who's really taking care of these patients on the bedsides … the nurses are, I would say, equal partners to physicians when it comes to shock."

The researchers are getting feedback about the study from all over the world, according to the doctor, and trials are underway in other hospitals.

Jeffrey D. Allred, Deseret News

"Because cardiogenic shock is so widely considered as a major unmet need in contemporary cardiovascular disease in general … cardiogenic shock was identified as one of the problems that we need to address, and now that these promising results are out, more and more people are coming together either in the form of doing a registry study or clinical trial and trying to implement these teams," Drakos said.

Though the idea of creating a multidisciplinary team might sound simple, it's "easier said than done."

"And the reason it's easier said than done is because you need to have a collaborative infrastructure and mentality. And here at the University of Utah, we have a long history of working together in teams, especially our heart failure transplant team and our cardiovascular team in general," Drakos said.

"So I think it's something that others can also do if they see the benefit, but unless you already have the culture of working together with other specialties in a very collaborative way for a long time, it requires an institutional culture of change."

Results at the U. hospital were "more of a confirmation than a surprise," according to Drakos.

Jeffrey D. Allred, Deseret News

Though the idea might be adapted differently in other hospitals, "the concept will be a team approach. It might not be the exact same team composition from institution to institution."

While Phillips waits for a heart transplant, he says his support group helps him through, including his wife, who's been "in front of me, beside me, and behind me, and that's helped quite a bit."

He says he fights to stay alive for his wife.

"I do a lot of fighting, but it's definitely worth it to me," Phillips said.

Myrna Phillips called the experience "life changing."

"It definitely teaches you patience. It teaches you selflessness. It teaches you that, all the little things that you think matter, clothes, things that you think you have to have just become nothing compared to what actually becomes the reality of what you need to have, a good partner in life. It brings a lot to light."

Correction: In a previous version of this story's photo gallery, Jen Chung-Peck's last name was incorrectly spelled Chung-Peak.