Dec. 16, 2025
A collaborative team at Mayo Clinic in Florida is transforming outcomes for patients with cardiogenic shock through a regional initiative called the JAX Cardiogenic Shock Consortium (JAX Shock). The multidisciplinary network unites hospitals, physicians and specialists to deliver faster, more coordinated care for one of cardiology's most time-critical emergencies.
A race against time
Cardiogenic shock occurs when the heart fails to pump enough blood to sustain the body's organs. Without rapid intervention, mortality can reach 50% or higher.
"In cardiogenic shock, time equals survival," says Parag C. Patel, M.D., a transplant cardiologist at Mayo Clinic in Jacksonville, Florida. "The faster you can manage these patients, the better their outcomes. Even a few hours can make the difference between recovery and irreversible organ failure. Teamwork across the entire spectrum of care is essential for successful outcomes."
Before JAX Shock began in 2018, many patients were arriving too late at advanced medical centers such as Mayo Clinic.
"We were seeing patients when they were extremely ill," Dr. Patel says. "Rather than stabilize and send them for additional care, hospitals were trying to stabilize locally and only transferring at the last moment. That gave us little opportunity for recovery."
A regional survey also revealed that fewer than 20% of patients were receiving pulmonary artery catheters despite evidence that these monitoring tools improve outcomes. Dr. Patel notes that appropriate use should be 70% or above.
Building a collaborative network
Recognizing the need for earlier, standardized care, physicians helped launch JAX Shock as a hub-and-spoke model connecting cardiologists, intensivists, cardiac surgeons, anesthesiologists and critical care specialists across the region. Importantly, the program is a collaborative effort and not exclusive to Mayo Clinic.
"Every participating institution shares ownership of the structure and content," Dr. Patel says. "When everyone has buy-in, they make sure it succeeds."
The consortium meets about four times a year — originally for education, but now to review real-world cases and outcomes.
"We talk openly about what went well and what didn't," Dr. Patel says. "We're focused on leveling up the playing field for everyone and improving the patient outcomes for our entire region."
Strengthening local infrastructure
JAX Shock also helps hospitals strengthen their systems for recognizing and managing cardiogenic shock. Early on, Mayo Clinic physicians saw varied expertise and resources across local hospitals. The consortium responded with tailored education and process improvements suited to each institution's capabilities.
Training emphasizes early recognition, shock phenotyping and local management. For smaller hospitals, this includes simple steps such as teaching teams to check three key labs — lactate, creatinine and liver enzymes — whenever a patient is hypotensive.
"The goal is for every team to have the tools to act fast and know when to call," Dr. Patel says.
A streamlined transfer and response system
At the hub, Mayo Clinic coordinates a rapid, multidisciplinary response whenever a patient requires higher level intervention. The team uses a tier alert system — a hospital-to-hospital communication network for urgent conditions such as cardiogenic shock. When a referring physician calls, key specialists quickly connect to coordinate logistics and plan care.
"Within minutes, everyone's on the same call — the referring physician, surgeon, cardiologist, intensivist and critical care team — deciding what needs to happen next," Dr. Patel explains. "If the patient needs ECMO, our operating room team is already in the hospital before the patient arrives."
The goal, however, isn't just faster transfer; it's smarter timing. Referring physicians are encouraged to call at the first suspicion of cardiogenic shock, regardless of whether there is a planned transfer.
"We'd rather hear about 10 patients who aren't in shock than miss the one who is," Dr. Patel says.
A regional turnaround in shock survival
Since the launch of JAX Shock, patient outcomes have improved dramatically. Survival for the sickest patients requiring temporary mechanical support has climbed to 85%. Earlier and more frequent transfers drove much of that success, increasing by 30% a year in the program's early stages.
Within Mayo Clinic, cardiogenic shock mortality dropped from 64% before the program to 25% immediately after. Today, it averages between 15% and 20%. Increased referrals support growth in the advanced heart failure and transplant program, giving more patients access to lifesaving interventions. Still, Dr. Patel stresses that transplant volume isn't the goal.
"If we can avoid a transplant, we would rather avoid it," he says. "A success is anybody we can get out of our facilities and back to their life. We focus on recovery, not replacement."
Anticipating the next stage of shock care
The next frontier for JAX Shock is early identification — stopping cardiogenic shock before it fully develops. Mayo Clinic experts use an electronic health record-based algorithm that tracks over 1,400 clinical variables to monitor patient status in real time. The team is developing predictive models that can forecast deterioration 6 to 8 hours before onset.
Referring physicians should reach out early whenever they suspect cardiogenic shock. As Dr. Patel emphasizes, the sooner the call comes, the greater the chance of survival.
For more information
Refer a patient to Mayo Clinic.