The first FDA-approved automated tool that classifies and tracks cardiogenic shock provides patient data in real time, helping clinicians see information that’s often unrecognized and to quickly prioritize care.

The Etiometry Cardiogenic Shock Tool combines physiologic data with electronic health records, as well as laboratory and device inputs. It uses the Society for Cardiovascular Angiography & Interventions (SCAI) guidelines and staging to provide clinicians with continuous data about the status of their patients.

“The tool can, on a second–by–second basis, find instances of hypotension, find instances of hypoperfusion, find what type of support the patient is getting in terms of devices or medications and assign a very well understood classification of the severity of cardiogenic shock,” said Dimitar Baronov, co-founder and chief technology officer of Etiometry.

The Etiometry platform uses AI in a layered system: first identifying who the patient is clinically, then tracking whether they are improving or deteriorating, and finally detecting when a specific complication is emerging.

“Cardiogenic shock is a clear example: Its early warning signs are spread across many continuously changing hemodynamics — blood flow, pressure, and the circulation of blood throughout the cardiovascular system — that are difficult to distill and interpret together at the bedside. In our approach, the architecture brings all of the hemodynamic signals together to provide the clinical intelligence, while AI serves as the engine matched to the question,” Baronov said.

Walter Schiffer, MD, a cardiologist at Washington University School of Medicine in St. Louis who uses the tool, said that despite increased awareness, cardiogenic shock still often goes unrecognized. This tool helps to integrate and analyze the torrent of information generated about each patient to pick out patterns that might otherwise be missed, he said.

“Where I find the platform to be most useful is in assessing these continuous hemodynamic variables that are otherwise very hard to capture, either just by talking about them or writing them down on a sheet of paper,” he said.

Schiffer says the tool also helps to prioritize which patients need the most attention, and potentially start treatment earlier, improving the odds of survival.

“Because there’s automated SCAI staging built in, when I’m getting to know the patients and getting to know the unit, I look at the dashboard, which tells me the specific SCAI shock stage and trajectory of each of my patients,” he said. “So I can pretty easily triage and understand who my sickest patients are.”

Srihari Naidu, MD, the president of SCAI, who led the development of the SCAI classification system, said he was pleased to see the system being integrated into clinical intelligence platforms where it can help speed up treatment.

“The Holy Grail of shock is to identify it sooner, so if you can identify patients in stage B before they become C, you can treat them much earlier,” said Naidu, a professor at the New York Medical College School of Medicine in Valhalla, and Westchester Medical Center in Garden City, both in New York. “Because once they get more sick and things start dying in the body it’s hard to bring them back. But if you catch them before the dominos start to fall then you can reverse that.”

Baronov said the next step in the development of the tool is to use it to more accurately predict the trajectory of a patient in cardiogenic shock, and even the outcome of different therapeutic interventions — identifying which patients require medication or more aggressive mechanical support.

“We believe that we are uniquely positioned to use this as a stepping stone to this more advanced kind of prediction of the pharmacodynamic effects of various medications, what can work, what cannot work, and what are the right interventions at the right time,” he said.

Schiffer reported being on the Etiometry advisory board and receiving funding from Abiomed and Johnson & Johnson for research in collaboration with Etiometry. Naidu reported having relevant financial relationships.

Brian Owens is a freelance journalist based in New Brunswick, Canada.