Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
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).
| Errataetall: |
CommentIn: JACC Heart Fail. 2023 Feb;11(2):188-190. - PMID 36752486 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
JACC. Heart failure - 11(2023), 2 vom: 11. Feb., Seite 176-187 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hernandez-Montfort, Jaime [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiogenic shock |
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| Anmerkungen: |
Date Completed 11.02.2023 Date Revised 05.04.2023 published: Print-Electronic ClinicalTrials.gov: NCT04682483 CommentIn: JACC Heart Fail. 2023 Feb;11(2):188-190. - PMID 36752486 Citation Status MEDLINE |
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| doi: |
10.1016/j.jchf.2022.10.002 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM348562705 |
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| 100 | 1 | |a Hernandez-Montfort, Jaime |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 11.02.2023 | ||
| 500 | |a Date Revised 05.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT04682483 | ||
| 500 | |a CommentIn: JACC Heart Fail. 2023 Feb;11(2):188-190. - PMID 36752486 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Heart failure-related cardiogenic shock (HF-CS) remains an understudied distinct clinical entity | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
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| 650 | 4 | |a cardiogenic shock | |
| 650 | 4 | |a heart failure | |
| 650 | 4 | |a heart replacement therapy | |
| 650 | 4 | |a native heart survival | |
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