Practice Variation in Vasoactive Medication Use for Cardiogenic Shock Across ICU Subtypes: A Retrospective Cohort...

Area of Science:

• Critical Care Medicine
• Cardiology
• Pharmacology

Background:

• Cardiogenic shock presents significant morbidity and mortality.
• Vasoactive and inodilator management strategies vary widely.
• The influence of clinical practice variation versus patient factors on these therapies is not well understood.

Purpose of the Study:

• To investigate the extent to which patient-level variables and clinical practice variation explain differences in vasoactive and inodilator therapy use for cardiogenic shock.
• To compare inodilator medication utilization across different intensive care unit (ICU) settings.

Main Methods:

• Analysis of 4,525 patients admitted to Michigan Medicine ICUs between 2014-2023 with cardiogenic shock.
• Comparison of vasoactive and inodilator medication use across cardiovascular, cardiovascular surgical, and non-cardiac ICUs.
• Mixed-effect logistic modeling to assess the contribution of patient-level variables and ICU location to treatment variation.

Main Results:

• Inodilator use varied significantly by ICU setting, being highest in cardiac and cardiothoracic surgical ICUs and lowest in non-cardiac ICUs.
• Patient factors like heart failure increased inodilator use, while older age, male sex, and prior cardiac arrest decreased it.
• ICU location accounted for 15.8% of the variance in inodilator use, compared to 6.1% for patient-level variables.

Conclusions:

• A significant portion of the variation in vasoactive medication utilization for cardiogenic shock is attributable to the ICU setting.
• Clinical practice variation, particularly the ICU environment, is a key determinant of inodilator therapy in cardiogenic shock.