Geographic Access to Care and Mortality in Cardiogenic Shock: A Nationwide Cohort Analysis.

IMPORTANCE

Timely access to advanced care is critical for patients with cardiogenic shock (CS), yet the impact of regional disparities in hospital arrival time on mortality remains unclear.

OBJECTIVES

To investigate whether regional disparities in hospital arrival time are associated with in-hospital and long-term mortality among patients with CS.

DESIGN

Population-based, nationwide cohort study.

SETTING

Tertiary hospitals in South Korea, using data from the Korean National Health Insurance Service database and regional hospital accessibility indicators from the Korea Transport Institute.

PARTICIPANTS

A total of 80,263 adults (≥ 18 yr) admitted to an ICU with a diagnosis of CS between 2017 and 2022. The study population was stratified by estimated hospital arrival time using region-level average daytime travel times (< 10, 10-30, 30-60, and > 60 min) for the present study.

INTERVENTIONS: None.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality, including in-hospital and post-discharge mortality. Multivariable logistic and Cox regression models were used to assess associations.

RESULTS

Median estimated hospital arrival time was 9.15 minutes. In-hospital mortality increased progressively with longer arrival times: 29.6% (< 10 min), 33.5% (10-30 min), 34.9% (30-60 min), and 38.8% (> 60 min). Compared with less than 10 minutes, the adjusted odds ratios for in-hospital mortality were 1.27 (95% CI, 1.23-1.32), 1.24 (95% CI, 1.14-1.35), and 1.51 (95% CI, 1.29-1.75), respectively. At 1-year follow-up, the adjusted hazard ratios for all-cause mortality were 1.16 (95% CI, 1.14-1.19 for 10-30 min), 1.16 (95% CI, 1.09-1.21 for 30-60 min), and 1.31 (95% CI, 1.19-1.43 for > 60 min), relative to less than 10 minutes. These associations were consistent in both de novo and acute-on-chronic CS.

CONCLUSIONS

Longer hospital arrival times are significantly associated with increased in-hospital and long-term mortality in patients with CS. These findings underscore the need for system-level interventions, such as regionally coordinated shock networks and early prehospital triage, to ensure timely access to definitive care.