Implementation of shock teams and impact on the therapeutic approach and prognosis of cardiogenic shock in Spain.

OBJECTIVE

There are no data on the implementation of shock teams (ST) or their impact on cardiogenic shock (CS) in Spain.

METHODS

We conducted a retrospective observational study including episodes of CS (2016-2022) from hospitals within the Spanish National Health System with availability of an Interventional Cardiology Unit. The population was divided into a) patients hospitalized in centers with ST (CS-ST) and b) patients hospitalized in centers without ST (CSNST). Furthermore, the availability of a cardiac intensive care unit (CICU), cardiac surgery, heart transplant program, and volume of CS cases at each center were recorded. The outcome variable was the in-hospital mortality rate.

RESULTS

A total of 15,879 episodes were analyzed, 32% (5,095) of which corresponded to the CS-ST group. The proportion of  enters with ST availability increased progressively from 7% in 2016 to 39% in 2022. Patients from the CS-ST group were younger (68 vs 71 years, P < .001) and more frequently underwent mechanical ventilation, renal replacement therapy, and circulatory support (P < .001), showing a higher rate of acute kidney failure and stroke and longer lengths of stay (12 days vs 9 days, P < .001). Care in centers with ST (OR, 0.86; 95% CI, 0.77-0.96; P = .005) and CICU (OR, 0.82; 95% CI, 0.69-0.98; P < .033) was significantly associated with a lower mortality rate.

CONCLUSIONS

The availability of ST has expanded in our setting. Patients admitted to centers with ST are managed more invasively, with a lower in-hospital mortality rate despite a higher rate of complications.