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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Cardiogenic shock related cardiovascular disease mortality trends in US population: Heart failure vs. acute

Alireza Ghajar1, Cesar Palacios Ordonez2, Binu Philips3

  • 1Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA, USA.

International Journal of Cardiology
|August 24, 2022
PubMed

Insights

Mortality from cardiogenic shock (CS) due to heart failure (HF-CS) is rising, particularly in younger adults and minority populations, while CS from acute myocardial infarction (AMI-CS) has declined. This highlights distinct trends and necessitates updated intensive care strategies.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Cardiogenic shock (CS) mortality from acute myocardial infarction (AMI) has decreased with early revascularization.
  • CS due to heart failure (HF) is a distinct entity with less understood mortality trends.
  • Understanding these differences is crucial for evolving critical care management.

Purpose of the Study:

  • To analyze national trends in age-adjusted mortality rates (AAMR) for CS related to HF versus AMI.
  • To identify demographic and geographic disparities in CS mortality.
  • To inform future strategies for managing CS patients.

Main Methods:

  • Nationwide observational study using the CDC WONDER database (1999-2020).
  • Analysis of age-adjusted mortality rates (AAMR) per 100,000 for CS (HF vs. AMI) in adults aged 35-84.
  • Comparison of mortality trends across different demographics and geographic locations.

Main Results:

  • AMI-CS mortality decreased significantly from 1999-2009 then stabilized; HF-CS mortality rose steadily from 2009-2020.
  • Males had nearly double the mortality rates of females for both HF-CS and AMI-CS.
  • HF-CS mortality increased faster in non-Hispanic Black individuals than non-Hispanic White individuals; AMI-CS mortality remained higher in rural areas.

Conclusions:

  • HF-CS and AMI-CS are distinct clinical entities with diverging mortality trends.
  • Increasing HF-CS mortality, especially in younger populations (<65), signals a demographic shift in CS patients.
  • Current intensive care unit strategies may need reevaluation to address the changing landscape of CS.
Abstract

Keywords:
Acute myocardial infarctionCardiogenic shockHeart failureRace/gender/geographic variationsUS mortality trends

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