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Shock in the cardiac intensive care unit: Changes in epidemiology and prognosis over time
Jacob C Jentzer1, Abdelrahman M Ahmed2, Saraschandra Vallabhajosyula1
1Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN.
Insights
The incidence of shock in cardiac intensive care units has risen, with heart failure increasingly causing cardiogenic shock. Despite this, overall mortality for shock patients has decreased over time.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Epidemiology
Background:
- Few studies document the evolving epidemiology and outcomes of shock within cardiac intensive care units (CICUs).
- Understanding temporal trends in shock is crucial for optimizing patient care and resource allocation in CICUs.
Purpose of the Study:
- To describe the changes in shock epidemiology and patient outcomes over time in a CICU population.
- To analyze trends in shock prevalence, subtypes, etiologies, and associated mortality within a decade.
Main Methods:
- Retrospective analysis of 1859 unique patients admitted to a CICU between 2007 and 2018 with a diagnosis of shock.
- Assessment of temporal trends in shock prevalence, causes, and mortality across 3-year intervals.
- Stratification of outcomes based on shock subtype (cardiogenic, septic, mixed) and underlying conditions (acute coronary syndrome, heart failure).
Main Results:
- Shock prevalence in CICU admissions increased from 8.8% in 2007 to 21.6% in 2018.
- Cardiogenic shock was the most common type (65%), with heart failure increasingly replacing acute coronary syndrome as its primary cause.
- Overall hospital mortality for shock patients decreased significantly over the study period.
Conclusions:
- The prevalence of shock in CICUs is increasing, characterized by a significant proportion of mixed cardiogenic-septic shock.
- The etiological landscape of cardiogenic shock has shifted, with heart failure becoming more prevalent than acute coronary syndrome.
- Despite increased prevalence, improved outcomes in cardiogenic shock patients, particularly those with heart failure, were observed.
Abstract:
There are few studies documenting the changing epidemiology and outcomes of shock in cardiac intensive care unit (CICU) patients. We sought to describe the changes in shock epidemiology and outcomes over time in a CICU population.
Methods:
We included 1859 unique patients admitted to the Mayo Clinic Rochester CICU from 2007 through 2018 with an admission diagnosis of shock. Temporal trends, including mortality, were assessed across 3-year periods.
Results:
Shock comprised 15.1% of CICU admissions during the study period, increasing from 8.8% of CICU admissions in 2007 to 21.6% in 2018 (P < .01 for trend). Mean age was 68 ± 14 years (38% females). Shock was cardiogenic in 65%, septic in 10% and mixed cardiogenic-septic in 15%. Concomitant diagnoses in patients with cardiogenic shock (CS) included acute coronary syndrome (ACS) in 17%, heart failure (HF) in 35% and both in 40%. There was no significant change in the prevalence of individual shock subtypes over time (P > .1). Among patients with CS, the prevalence of ACS decreased and the prevalence of HF increased over time (P < .01). Hospital mortality was highest among patients with mixed shock (39%; P = .05). Among patients with CS, hospital mortality was lower among those with HF compared to those without HF (31% vs. 40%, P < .01). Hospital mortality decreased over time among patients with shock (P < .01) and CS (P = .02).
Conclusions:
The prevalence of shock in the CICU has increased over time, with a substantial prevalence of mixed CS. The etiology of CS has changed over the last decade with HF overtaking ACS as the most common cause of CS in the CICU.
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