Work

Short term outcomes and resource utilization in de-novo versus acute on chronic heart failure related cardiogenic shock: a nationwide analysis

Year: 2024

Type: article

Abstract: Background There has been growing recognition of non-ischemic etiologies of cardiogenic shock (CS). To further understand this population, we aimed to investigate differences in clinical course between acute on chronic (CHF-CS) and de-novo CS (DN-CS). Methods Using the Nationwide Readmission Database, we examined 140,118 CS cases. Outcomes of interest included in-hospital and 30-day outcomes and use of critical care and advanced heart failure therapies. Results Patients with DN-CS had higher in-hospital mortality than the CHF-CS cohort (31.7% vs 29.3%, p<0.001). Renal replacement therapy (14.6% vs 13.2%, p=<0.001) and right heart catheterization (23.93% vs 18.3%, p<0.001) were implemented more in the CHF-CS cohort. Mechanical circulatory support (9.3% vs 12.9%, p<0.001) was more utilized in DN-CS. The CHF-CS cohort was more likely to undergo LVAD implantation (3.9% vs 0.5%, p<0.001) and heart transplantation (2.0% vs 0.5%, p<0.001). Over the study period, critical care and heart failure therapy utilization increased, but the proportion of patients receiving these interventions remained unchanged. Thirty days after index hospitalization, the CHF-CS cohort had more readmissions for heart failure (2.6% vs 1.2%, p<0.001) and all causes (21.1% vs 14.3%, p<0.001) with higher readmission mortality (2.4% vs 1.2%, p<0.001). Conclusion Our findings align with existing research, demonstrating higher in-hospital mortality in the DN-CS subgroup. After the index hospitalization, however, the CHF-CS cohort performed worse with higher all-cause readmission rate and readmission mortality. The study also underscores the need for further investigation into the underutilization of certain interventions and the observed trends in the management of these CS subgroups.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2024.1454884

Authors: Mary Quien, Ju Young Bae, Sun-Joo Jang, Carlos Davila

Institutions: Bridgeport Hospital, Yale University, Yale New Haven Hospital

Language: English

Topic: Mechanical Circulatory Support Devices

Subfield: Biomedical Engineering

Field: Engineering

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,295