Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.

About the Episode:

This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.

Topics Covered

Defining Long-Term Outcomes:

• Beyond survival: functional independence, mental health, cognition, and system resource use.

Key Findings from Ontario Cohort

• 42% of cardiogenic shock survivors require increased levels of care

• 15% die within a year post-discharge

• Modest impact of revascularization or mechanical support on long-term outcomes

Morbidity and Quality of Life

• Loss of independence and inability to return to work

• High incidence of PTSD, depression, and caregiver burden

• Delayed functional recovery and unmet expectations

Prognostic Factors and Predictive Markers

• Frailty as a key indicator

• Pre-existing mental health as a predictor of post-ICU mental health outcomes

• In-hospital arrest characteristics: rhythm, downtime, comorbidities

ICU Follow-Up Clinics

• Value in knowledge translation and emotional support

• Real-world insights on functional recovery and patient satisfaction

• Common patient sentiment: gratitude mixed with trauma

• Communication with Families

• Avoiding value imposition

Emphasizing trajectory over fixed timelines

• Balancing hope with realism

Rethinking Endpoints in Research

• Limitations of 28-day mortality

• Need for patient-centered, long-term functional outcomes

• Trajectory-based data over snapshot metrics

• Knowledge Translation as the Intervention

Equipping clinicians and patients with realistic expectations

• Normalizing psychological responses

• Shaping future research directions around lived experience