Automated SCAI Staging as a Novel Decision Aid in Cardiogenic Shock Management.

Area of Science:

• Cardiology
• Medical Informatics
• Critical Care Medicine

Background:

• Early serial staging of cardiogenic shock (CS) using the Society for Cardiovascular Angiography and Interventions (SCAI) system has demonstrated prognostic value in retrospective analyses.
• However, the utility of automated SCAI staging as a clinical decision support tool remains underexplored.

Purpose of the Study:

• To develop and implement an automated, electronic medical record (EMR)-integrated CS staging tool.
• To evaluate provider adoption and the impact of this tool on clinical practice and patient management.

Main Methods:

• The 2022 CS Working Group-modified SCAI criteria were adapted into an automated EMR-based scoring system, providing CS patient staging every 6 hours.
• A comparative analysis was conducted, assessing patient characteristics, SCAI stage documentation rates, and CS management strategies before and after the implementation of automated staging.

Main Results:

• Automated staging led to a significant increase in SCAI stage documentation in the Cardiac Intensive Care Unit, from 13.0% to 50.0% (p <0.001).
• CS surveillance at 72 hours using serial lactate and alanine aminotransferase (ALT) also increased significantly.
• Within the automated cohort, 24-hour SCAI stage was associated with myocardial recovery (p=0.001), need for heart replacement therapies (p=0.008), and in-hospital mortality (p=0.067).

Conclusions:

• Early, serial, and automated CS staging can be effectively implemented using EMR integration.
• This automated approach provides valuable prognostic information, potentially facilitating improved CS management and patient outcomes.