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Published on: June 12, 2021
Temporary mechanical circulatory support utilization and outcomes in cardiogenic shock phenotypes: A comparative
Laith Alhuneafat1, Fares Ghanem2, Ahmad Jabri3
1Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.
Insights
Mechanical circulatory support (MCS) use increased in cardiogenic shock (CS) patients, but outcomes varied by cause. Acute myocardial infarction (AMI-CS) cases had worse complications than heart failure (HF-CS) cases despite shorter stays.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Cardiogenic shock (CS) is a critical condition with high mortality, primarily caused by heart failure (HF) or acute myocardial infarction (AMI).
- Understanding the trends and outcomes of mechanical circulatory support (MCS) in different CS etiologies is crucial for improving patient care.
Purpose of the Study:
- To compare MCS utilization rates, associated factors, and clinical outcomes between patients with HF-CS and AMI-CS.
- To analyze trends in MCS use from 2016 to 2020 using national inpatient data.
Main Methods:
- Retrospective analysis of the 2016-2020 National Inpatient Sample data.
- Inclusion of 329,280 patients diagnosed with cardiogenic shock (204,660 AMI-CS, 124,620 HF-CS).
- Comparison of MCS device utilization (IABP, ECMO, PVAD), patient demographics, comorbidities, and in-hospital outcomes.
Main Results:
- Overall MCS utilization increased, with higher rates in AMI-CS for IABP, ECMO, and PVAD compared to HF-CS.
- Factors associated with lower MCS use included female sex, older age, Black race, and various comorbidities.
- HF-CS patients experienced fewer adverse outcomes like death and stroke but had higher rates of acute renal failure requiring dialysis; AMI-CS patients had shorter hospital stays and lower charges.
Conclusions:
- Despite increased MCS use, cardiogenic shock patients face significant morbidity and mortality.
- The etiology of CS (AMI vs. HF) substantially impacts clinical outcomes and complications.
- A standardized, etiology-aware approach considering patient-specific factors and equitable access is needed for optimal CS management.
Introduction:
Cardiogenic shock (CS) is marked by substantial morbidity and mortality. The two major CS etiologies include heart failure (HF) and acute myocardial infarction (AMI). The utilization trends of mechanical circulatory support (MCS) and their clinical outcomes are not well described.
Methods:
This study compares the rates of MCS utilization, factors associated with utilization, and clinical outcomes in patients who present with HF-CS and AMI-CS, using 2016-2020 National Inpatient Sample data.
Results:
The study included 329,280 patients, comprising 204,660 cases of AMI-CS and 124,620 of HF-CS. MCS utilization increased over the study period with variable degree among devices, and CS-phenotype. AMI-CS had higher intraaortic balloon pump (32.4 % vs. 8.9 %), extracorporeal membrane oxygenation (2.8 % vs. 2.4 %), and percutaneous ventricular assist device use (14.5 % vs. 8.1 %) compared to HF-CS (p < 0.01). Factors linked to lower MCS use were female sex, age over 60 years, Black race, atrial fibrillation, chronic obstructive lung disease, diabetes mellitus, cirrhosis, previous stroke, or myocardial infarction. After adjusting for various factors, patients with HF-CS vs. AMI-CS had significantly fewer adverse outcomes, including inpatient death, stroke, tracheostomy, mechanical ventilation, and blood transfusion. However, HF-CS had higher odds of acute renal failure requiring dialysis. AMI-CS was associated with shorter hospital stays (8.8 vs. 15.0 days, p < 0.001), lower charges ($251,580 vs. $294,792, p < 0.001), and were less likely to discharge home.
Conclusion:
Despite the evolving trends in MCS utilization over time, CS patients still face high morbidity and mortality rates. The underlying shock etiology has a substantial impact on outcomes, with AMI cases demonstrating worse complications. This highlights the need for a standardized approach that also takes into consideration etiology, patient-specific factors, care availability, and equitable access.
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