Journal article
Outcomes of Patients Transferred to Tertiary Care Centers for Treatment of Cardiogenic Shock: A Cardiogenic Shock Working Group Analysis
Journal of cardiac failure, v 30(4), pp 564-575
Apr 2024
PMID: 37820897
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Consensus recommendations for cardiogenic shock (CS) advise transfer of patients in need of advanced options beyond the capability of "spoke" centers to tertiary/"hub" centers with higher capabilities. However, outcomes associated with such transfers are largely unknown beyond those reported in individual health networks.
To analyze a contemporary, multicenter CS cohort with the aim of comparing characteristics and outcomes of patients between transfer (between spoke and hub centers) and nontransfer cohorts (those primarily admitted to a hub center) for both acute myocardial infarction (AMI-CS) and heart failure-related HF-CS. We also aim to identify clinical characteristics of the transfer cohort that are associated with in-hospital mortality.
The Cardiogenic Shock Working Group (CSWG) registry is a national, multicenter, prospective registry including high-volume (mostly hub) CS centers. Fifteen U.S. sites contributed data for this analysis from 2016-2020.
Of 1890 consecutive CS patients enrolled into the CSWG registry, 1028 (54.4%) patients were transferred. Of these patients, 528 (58.1%) had heart failure-related CS (HF-CS), and 381 (41.9%) had CS related to acute myocardial infarction (AMI-CS). Upon arrival to the CSWG site, transfer patients were more likely to be in SCAI stages C and D, when compared to nontransfer patients. Transfer patients had higher mortality rates (37% vs 29%, < 0.001) than nontransfer patients; the differences were driven primarily by the HF-CS cohort. Logistic regression identified increasing age, mechanical ventilation, renal replacement therapy, and higher number of vasoactive drugs prior to or within 24 hours after CSWG site transfer as independent predictors of mortality among HF-CS patients. Conversely, pulmonary artery catheter use prior to transfer or within 24 hours of arrival was associated with decreased mortality rates. Among transfer AMI-CS patients, BMI > 28 kg/m
, worsening renal failure, lactate > 3 mg/dL, and increasing numbers of vasoactive drugs were associated with increased mortality rates.
More than half of patients with CS managed at high-volume CS centers were transferred from another hospital. Although transfer patients had higher mortality rates than those who were admitted primarily to hub centers, the outcomes and their predictors varied significantly when classified by HF-CS vs AMI-CS.
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Details
- Title
- Outcomes of Patients Transferred to Tertiary Care Centers for Treatment of Cardiogenic Shock: A Cardiogenic Shock Working Group Analysis
- Creators
- A Reshad Garan - Beth Israel Deaconess Medical CenterRachna Kataria - LifespanBorui Li - Tufts Medical CenterShashank Sinha - Inova Fairfax HospitalManreet K Kanwar - Allegheny Health NetworkJaime Hernandez-Montfort - Baylor Scott & White HealthSong Li - University of Washington Medical CenterVAN-Khue Ton - Massachusetts General HospitalVanessa Blumer - Inova Fairfax HospitalE Wilson Grandin - Beth Israel Deaconess Medical CenterNeil Harwani - Tufts Medical CenterPeter Zazzali - Tufts Medical CenterKarol D Walec - Tufts Medical CenterGavin Hickey - University of Pittsburgh Medical CenterJacob Abraham - Hope Heart InstituteClaudius Mahr - University of Washington Medical CenterSandeep Nathan - University of ChicagoEsther Vorovich - Northwestern MedicineMaya Guglin - Indiana University HealthShelley Hall - Baylor Scott & White HealthWissam Khalife - The University of Texas Medical Branch at GalvestonPaavni Sangal - Tufts Medical CenterYijing Zhang - Tufts Medical CenterJu H Kim - Houston MethodistAndrew Schwartzman - Maine Medical CenterAlec Vishnevsky - Thomas Jefferson University HospitalDaniel Burkhoff - Cardiovascular Research FoundationNavin K Kapur - Tufts Medical Center
- Publication Details
- Journal of cardiac failure, v 30(4), pp 564-575
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001226582500001
- Scopus ID
- 2-s2.0-85178319290
- Other Identifier
- 991021932198504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems