Implementation and outcomes of a regional cardiogenic shock network in the UK

Background A recent UK society-endorsed consensus document recommended the creation of regional cardiogenic shock networks to facilitate transfer of patients to high-volume tertiary shock centres; there are currently no UK-specific data describing patients managed within such networks. Methods In this observational cohort study, we describe the implementation of a regional cardiogenic shock network covering a population of 3.5 million in North and East London. We analysed two cohorts: (1) all patients with cardiogenic shock admitted to a tertiary shock centre intensive care unit from 1 May 2023 to 31 May 2025 and (2) all patients referred from referring hospitals via the shock network from 1 April 2024 to 30 November 2025. Results Among 266 patients in the intensive care unit admissions cohort, 82% were admitted via nationally commissioned cardiovascular pathways and 18% via local cardiogenic shock network pathways. The most common aetiology was acute myocardial infarction (52%), followed by heart failure (30%) and secondary cardiogenic shock (18%). Mortality was 45% at 30 days and 52% at ultimate hospital discharge. Among 145 patients in the shock network referrals cohort, the most common aetiology was heart failure (46%) followed by acute myocardial infarction and secondary cardiogenic shock (both 22%). 49% of referrals were out-of-hours. 45 patients (31%) were transferred with a median time from decision to accept to patient arrival of 3.2 hours. Mortality at 30 days was 36% in patients transferred successfully, 21% in patients managed locally with advice and 74% in patients not transferred on the basis of perceived lack of benefit. Conclusions Implementation of a cardiogenic shock network facilitated rapid triage and transfer of select patients and may address gaps in access to specialist cardiac care for patients with cardiogenic shock not due to ST-elevation myocardial infarction. Prospective multicentre evaluation is needed to determine effects on patient outcomes and resource use.