Quien Mary, Bae Ju Young, Jang Sun-Joo, Davila Carlos
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, United States.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, United States.
Front Cardiovasc Med. 2024 Sep 9;11:1454884. doi: 10.3389/fcvm.2024.1454884. eCollection 2024.
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 heart failure related (CHF-CS) and de-novo CS (DN-CS).
Using the Nationwide Readmission Database, we examined 92,426 CS cases. Outcomes of interest included in-hospital and 30-day outcomes and use of advanced heart failure therapies.
Patients with DN-CS had higher in-hospital mortality than the CHF-CS cohort (32.6% vs. 30.4%, < 0.001). Mechanical circulatory support (11.9% vs. 8.6%, < 0.001) was more utilized in DN-CS. Renal replacement therapy (13.8% vs. 15.5%, < 0.001) and right heart catheterization (16.0% vs. 21.0%, < 0.001) were implemented more in the CHF-CS cohort. The CHF-CS cohort was also more likely to undergo LVAD implantation (0.4% vs. 3.6%, < 0.001) and heart transplantation (0.5% vs. 2.0%, < 0.001). Over the study period, advanced 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 (1.1% vs. 2.4%, < 0.001) and all causes (14.1% vs. 21.1%, < 0.001) with higher readmission mortality (1.1% vs. 2.3%, < 0.001).
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.
心源性休克（CS）的非缺血性病因已得到越来越多的认识。为了进一步了解这一人群，我们旨在研究急性慢性心力衰竭相关的心源性休克（CHF-CS）和新发心源性休克（DN-CS）在临床病程上的差异。
利用全国再入院数据库，我们检查了92426例心源性休克病例。感兴趣的结局包括住院期间和30天的结局以及晚期心力衰竭治疗的使用情况。
DN-CS患者的住院死亡率高于CHF-CS队列（32.6%对30.4%，P<0.001）。DN-CS中机械循环支持的使用率更高（11.9%对8.6%，P<0.001）。CHF-CS队列中更多地实施了肾脏替代治疗（13.8%对15.5%，P<0.001）和右心导管检查（16.0%对21.0%，P<0.001）。CHF-CS队列也更有可能接受左心室辅助装置植入（0.4%对3.6%，P<0.001）和心脏移植（0.5%对2.0%，P<0.001）。在研究期间，晚期心力衰竭治疗的使用率有所增加，但接受这些干预措施的患者比例保持不变。在首次住院30天后，CHF-CS队列因心力衰竭再次入院的比例更高（1.1%对2.4%，P<0.001），因各种原因再次入院的比例也更高（14.1%对21.1%，P<0.001），再次入院死亡率也更高（1.1%对2.3%，P<0.001）。
我们的研究结果与现有研究一致，表明DN-CS亚组的住院死亡率更高。然而，在首次住院后，CHF-CS队列的表现更差，全因再入院率和再入院死亡率更高。该研究还强调需要进一步调查某些干预措施的使用不足以及这些心源性休克亚组管理中观察到的趋势。
