ESC heart failure · 2025
Impact of standardized team-based care on cardiogenic shock outcomes over time.
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Tehrani Behnam N, Rosner Carolyn M, Fadahunsi Adetokunbo, Barker Kimberly, Batchelor Wayne B, Blumer Vanessa, Clevenger Lindsay, Desai Shashank, Ferri Michelle, Franke Evan, Kennedy Jamie, King Christopher, Howard Edward, Isseh Iyad, Lee Seiyon Ben, Mehta Aditya, Psotka Mitchell, Singh Ramesh, Sinha Shashank S, Sherwood Matthew W, Tang Daniel, Terek Megan, Truesdell Alexander G, Vavilin Ilan, O'Connor Christopher M
Аннотация
BACKGROUND AND AIMS: Limited data exist regarding the impact of standardized care on cardiogenic shock (CS) outcomes over time. We aimed to investigate the influence of multidisciplinary management on CS outcomes following implementation of team-based protocols in 2017.
METHODS: A total of 1453 consecutive patients enrolled into a single-centre CS registry were divided into two time periods, 2017-2019 versus 2020-2022. Baseline characteristics, management and outcomes were compared. The primary endpoint was adjusted in-hospital mortality. Multivariable regression analysis was performed to evaluate change in outcomes over time.
RESULTS: Compared with 2017-2019, more patients with CS were treated in 2020-2022 (930 vs. 523; P < 0.01). They more often presented to the Level 1 centre (52% vs. 45%; P = 0.01), with a higher proportion of heart failure-related CS (72% vs. 58%; P < 0.01) and Society for Cardiovascular Angiography and Interventions B and C CS (64% vs. 49%; P < 0.01). They were less likely to be managed with percutaneous ventricular assist devices (11% vs. 24%; P < 0.01) but more likely to receive veno-arterial extracorporeal membrane oxygenation (14% vs. 4%; P < 0.01) and heart transplantation (9% vs. 4%; P < 0.04). No differences were noted in in-hospital mortality [adjusted odds ratio (aOR) 0.81; 95% confidence interval (CI): 0.56-1.16; P = 0.25], major adverse cardiac and cerebrovascular events (aOR 1.21; 95% CI: 0.87-1.68; P = 0.26), stroke (aOR 1.11; 95% CI: 0.65-1.91; P = 0.71) or renal replacement therapy (aOR 0.95; 95% CI: 0.66-1.37; P = 0.77).
CONCLUSIONS: Standardized care for CS was associated with consistent in-hospital mortality over time despite changes in presentation and management. Further research is needed to identify the optimal care model during the vulnerable post-discharge period.
METHODS: A total of 1453 consecutive patients enrolled into a single-centre CS registry were divided into two time periods, 2017-2019 versus 2020-2022. Baseline characteristics, management and outcomes were compared. The primary endpoint was adjusted in-hospital mortality. Multivariable regression analysis was performed to evaluate change in outcomes over time.
RESULTS: Compared with 2017-2019, more patients with CS were treated in 2020-2022 (930 vs. 523; P < 0.01). They more often presented to the Level 1 centre (52% vs. 45%; P = 0.01), with a higher proportion of heart failure-related CS (72% vs. 58%; P < 0.01) and Society for Cardiovascular Angiography and Interventions B and C CS (64% vs. 49%; P < 0.01). They were less likely to be managed with percutaneous ventricular assist devices (11% vs. 24%; P < 0.01) but more likely to receive veno-arterial extracorporeal membrane oxygenation (14% vs. 4%; P < 0.01) and heart transplantation (9% vs. 4%; P < 0.04). No differences were noted in in-hospital mortality [adjusted odds ratio (aOR) 0.81; 95% confidence interval (CI): 0.56-1.16; P = 0.25], major adverse cardiac and cerebrovascular events (aOR 1.21; 95% CI: 0.87-1.68; P = 0.26), stroke (aOR 1.11; 95% CI: 0.65-1.91; P = 0.71) or renal replacement therapy (aOR 0.95; 95% CI: 0.66-1.37; P = 0.77).
CONCLUSIONS: Standardized care for CS was associated with consistent in-hospital mortality over time despite changes in presentation and management. Further research is needed to identify the optimal care model during the vulnerable post-discharge period.