Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock
Jaime Hernandez-Montfort, Manreet Kanwar, Shashank S Sinha, A Reshad Garan, Vanessa Blumer, Rachna Kataria, Evan H Whitehead, Michael Yin, Borui Li, Yijing Zhang, Katherine L Thayer, Paulina Baca, Fatou Dieng, Neil M Harwani, Maya Guglin, Jacob Abraham, Gavin Hickey, Sandeep Nathan, Detlef Wencker, Shelley Hall, Andrew Schwartzman, Wissam Khalife, Song Li, Claudius Mahr, Ju Kim, Esther Vorovich, Mohit Pahuja, Daniel Burkhoff, Navin K Kapur, Jaime Hernandez-Montfort, Manreet Kanwar, Shashank S Sinha, A Reshad Garan, Vanessa Blumer, Rachna Kataria, Evan H Whitehead, Michael Yin, Borui Li, Yijing Zhang, Katherine L Thayer, Paulina Baca, Fatou Dieng, Neil M Harwani, Maya Guglin, Jacob Abraham, Gavin Hickey, Sandeep Nathan, Detlef Wencker, Shelley Hall, Andrew Schwartzman, Wissam Khalife, Song Li, Claudius Mahr, Ju Kim, Esther Vorovich, Mohit Pahuja, Daniel Burkhoff, Navin K Kapur
Abstract
Background: Heart failure-related cardiogenic shock (HF-CS) remains an understudied distinct clinical entity.
Objectives: The authors sought to profile a large cohort of patients with HF-CS focused on practical application of the SCAI (Society for Cardiovascular Angiography and Interventions) staging system to define baseline and maximal shock severity, in-hospital management with acute mechanical circulatory support (AMCS), and clinical outcomes.
Methods: The Cardiogenic Shock Working Group registry includes patients with CS, regardless of etiology, from 17 clinical sites enrolled between 2016 and 2020. Patients with HF-CS (non-acute myocardial infarction) were analyzed and classified based on clinical presentation, outcomes at discharge, and shock severity defined by SCAI stages.
Results: A total of 1,767 patients with HF-CS were included, of whom 349 (19.8%) had de novo HF-CS (DNHF-CS). Patients were more likely to present in SCAI stage C or D and achieve maximum SCAI stage D. Patients with DNHF-CS were more likely to experience in-hospital death and in- and out-of-hospital cardiac arrest, and they escalated more rapidly to a maximum achieved SCAI stage, compared to patients with acute-on-chronic HF-CS. In-hospital cardiac arrest was associated with greater in-hospital death regardless of clinical presentation (de novo: 63% vs 21%; acute-on-chronic HF-CS: 65% vs 17%; both P < 0.001). Forty-five percent of HF-CS patients were exposed to at least 1 AMCS device throughout hospitalization.
Conclusions: In a large contemporary HF-CS cohort, we identified a greater incidence of in-hospital death and cardiac arrest as well as a more rapid escalation to maximum SCAI stage severity among DNHF-CS. AMCS use in HF-CS was common, with significant heterogeneity among device types. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483).
Keywords: cardiogenic shock; heart failure; heart replacement therapy; native heart survival.
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by National Institutes of Health RO1 grants to Dr Kapur (R01HL139785-01 and R01HL159089-01) and institutional grants from Abiomed Inc, Boston Scientific Inc, Abbott Laboratories, Getinge Inc, and LivaNova Inc to Tufts Medical Center. The sponsors had no input on the collection, analysis, and interpretation of the data or on the preparation, review, or approval of the manuscript. Dr Hernandez-Montfort is a consultant for Abiomed Inc and Abbott Laboratories. Dr Sinha is a consultant for Abiomed Inc. Dr Abraham is a consultant for Abbott Laboratories and Abiomed Inc. Dr Burkhoff has received an unrestricted educational grant from Abiomed Inc. Dr Kapur has received consulting honoraria and institutional grant support from Abbott Laboratories, Abiomed Inc, Boston Scientific, Medtronic, LivaNova, Getinge, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed