{
  "abstract": "Background: Cardiogenic shock (CS) may occur despite preserved blood pressure, contributing to delayed recognition and escalation to specialized care.\n\nProject Rationale: We implemented an interruptive electronic health record (EHR) alert designed to identify normotensive CS physiology and facilitate timely escalation to cardiac intensive care unit (CICU) consultation.\n\nProject Summary: We evaluated implementation of an interruptive EHR alert designed to identify patients with potential normotensive CS physiology at a tertiary academic medical center between December 2025 and March 2026. The alert incorporated an embedded escalation workflow allowing clinicians to directly order CICU consultation and/or repeat lactate measurement. Fifty alert triggers were analyzed. Clinician engagement with the alert workflow occurred in 14% of triggered alerts and was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%). Findings primarily demonstrated improved reliability of escalation decisions rather than changes in consultation timing once escalation occurred.\n\nTake-Home Messages: Normotensive CS is an under-recognized clinical phenotype associated with delayed escalation. EHR-based behavioral nudges embedded within clinician workflow may improve escalation reliability for high-risk patients with evolving shock physiology.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA",
    "Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA",
    "Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA",
    "Michigan Medicine, Health Information and Technology Services, Ann Arbor, Michigan, USA",
    "Michigan Medicine, Quality Department, Ann Arbor, Michigan, USA"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Sarah K. Adie"
    },
    {
      "affs": [
        2
      ],
      "name": "Matthew Kennedy"
    },
    {
      "affs": [
        1
      ],
      "name": "Adam Stein"
    },
    {
      "affs": [
        1
      ],
      "name": "Raymond A. Pashun"
    },
    {
      "affs": [
        3
      ],
      "name": "Christopher R. Zimmerman"
    },
    {
      "affs": [
        1
      ],
      "name": "Eric P. Cantey"
    },
    {
      "affs": [
        4
      ],
      "name": "Stephanie Steadman"
    },
    {
      "affs": [
        1
      ],
      "name": "Scott W. Ketcham"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/608hqxanwjge6.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jaccas.2026.109450",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13728289/",
  "id": "608hqxanwjge6",
  "issns": [
    "2666-0849"
  ],
  "landing_url": "https://doi.org/10.1016/j.jaccas.2026.109450",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Critical Care and Resuscitation"
    ],
    [
      "heading",
      "Quality Improvement Projects"
    ],
    [
      "openalex",
      "3605|Electronic Health Records Systems"
    ]
  ],
  "openalex": "W7213433584",
  "pdf_url": null,
  "pmcid": "PMC13728289",
  "pmid": "42752031",
  "published": "2026-09-16",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/608hqxanwjge6.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:24:00Z",
      "native_id": "PMC13728289",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jaccas.2026.109450"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge",
  "title_text": "Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:21:18Z",
  "url": "https://research.draconitic.com/paper/608hqxanwjge6",
  "venue": "JACC Case Reports",
  "versions": []
}