Journal article
Clinical Outcomes And Changes In Shock Severity Among Patients Hospitalized With Heart Failure Cardiogenic Shock
Journal of cardiac failure, v 29(4), pp 578-579
Apr 2023
Abstract
Heart failure-cardiogenic shock (HF-CS) is increasingly recognized as a distinct entity with underlying differences in clinical presentation and outcomes. Granular data defining clinical trajectories and outcomes associated with HF-CS are lacking.
The Cardiogenic Shock Working Group (CSWG) registry contains real-world data from patients hospitalized with CS across 17 clinical sites. For this analysis, HF-CS patients were sub-classified as having de novo HF-CS or acute-on-chronic HF-CS (ACHF). Clinical trajectories were assessed using the recently reported SCAI Staging system and clinical outcomes were analyzed.
A total of 1767 HF-CS patients were included in the analysis. Of these, 349 had de novo HF-CS (19.8%) and 1,371 (77.6%) had ACHF-CS. De novo HF-CS was triggered by various causes including conditions not primarily identified as HF (20%). Those with de novo HF-CS were more likely to experience out-of-hospital cardiac arrest (17.0% vs 7.5%) and in-hospital cardiac arrest (23.2% vs 11.6%), compared to ACHF-CS (both p<0.001). Patients with de novo HF-CS were significantly more likely to achieve native heart survival (58% vs 45%, p<0.001) or experience in-hospital mortality (32% vs 22%, p<0.001), when compared to ACHF-CS. Patients with de novo HF-CS were significantly less likely to undergo heart replacement therapy (HRT) when compared to ACHF-CS (33% vs 10%, p<0.001) (Figure 1A). Within 24 hours of admission, SCAI Stage C was the most common level of shock severity, regardless of HF-CS phenotype (p= 0.91). The incidence of SCAI Stage escalation was similar between de novo HF-CS and ACHF-CS irrespective of SCAI Stage severity within 24 hours of admission (Figure 1B). Patients with de novo HF-CS Stage C more rapidly escalated to their maximum achieved SCAI stage, when compared with ACHF-CS (101.1 vs 128.2 hours, p=0.04; Figure 1C).
Using a large contemporary real-world dataset of HF-CS, we identified that de novo HF-CS is associated with higher cardiac arrest, in-hospital mortality, and native heart survival, yet lower HRT compared to ACHF-CS. We further observed a significant number of HF-CS patients escalate in shock severity after hospital admission and with more rapid rates of SCAI Stage escalation among de novo HF-CS subjects. Further efforts to define shock trajectories and to phenotype HF-CS patients are urgently needed.
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Details
- Title
- Clinical Outcomes And Changes In Shock Severity Among Patients Hospitalized With Heart Failure Cardiogenic Shock
- Creators
- Vanessa Blumer - Duke Medical CenterJaime Hernandez-Montfort - Baylor Scott & White HealthManreet Kanwar - Allegheny Health NetworkRachna Kataria - Massachusetts General HospitalMichael Yin - University of UtahBorui Li - Boston, MAJacob Abraham - Providence Health & ServicesShashank Sinha - Inova Health SystemArthur Garan - Lahey Medical CenterKatherine Thayer - Duke Medical CenterYijing Zhang - Boston, MAShelley Hall - Baylor Scott & White HealthPaulina Baca - Boston, MAFatou Dieng - Tufts, Boston, MANeil Harwani - Boston, MAGavin Hickey - University of Pittsburgh Medical CenterDetlef Wencker - Baylor University Medical CenterWissam Khalife - The University of Texas Medical Branch Health, Friendswood, TXClaudius Mahr - University of WashingtonJu Kim - Houston MethodistEsther Vorovich - Northwestern UniversityDaniel Burkhoff - Cardiovascular Research FoundationNavin Kapur - Tufts Medical Center
- Publication Details
- Journal of cardiac failure, v 29(4), pp 578-579
- Publisher
- Elsevier
- Number of pages
- 2
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Other Identifier
- 991021932099004721