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Updated: Sep 9, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Higher hospital volume is associated with lower mortality for patients with cardiogenic shock and mechanical
Angela Dettling1,2, Caroline Kellner1,3, Jonas Sundermeyer1,2
1Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
High-volume cardiogenic shock (CS) and mechanical circulatory support (MCS) centers reduce patient mortality. Centralizing CS care in specialized, high-volume facilities may improve patient outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Mortality for cardiogenic shock (CS) remains high, necessitating improved treatment strategies.
- Centralization of CS treatment in specialized centers with expertise in mechanical circulatory support (MCS) is recommended to enhance patient outcomes.
- High-volume healthcare facilities may offer standardized and superior care for complex conditions like CS.
Purpose of the Study:
- To analyze the association between hospital volume of cardiogenic shock (CS) and mechanical circulatory support (MCS) cases and in-hospital mortality rates in Germany.
- To identify potential case thresholds for CS and MCS treatment that correlate with improved patient survival.
Main Methods:
- Utilized data from all CS patients treated in Germany between 2017-2021.
- Employed adjusted Cox-regression analysis to assess the relationship between annual CS/MCS hospital volume and in-hospital mortality.
- Used spline plots to visualize continuous associations and identify case thresholds.
Main Results:
- Treatment at hospitals with higher annual volumes of CS and MCS cases was significantly associated with lower in-hospital mortality risk.
- A continuous association was observed, without a ceiling effect, suggesting benefits across increasing volumes.
- Spline plots indicated potential beneficial case thresholds of at least 90 CS cases and 25 MCS cases per year.
Conclusions:
- Care for CS patients, with or without MCS, demonstrates lower in-hospital mortality in high-volume CS and MCS centers.
- Centralization of CS care in specialized centers managing high patient volumes could potentially lead to improved patient outcomes.
Aims:
Mortality for cardiogenic shock (CS) remains high. To improve outcomes, centralization of treatment in specialized centres, especially those with expertise in mechanical circulatory support (MCS), has been recommended. High-volume centres may be able to provide standardized, better care. We analysed associations between centre volume and outcomes in Germany, a large country with multiple types of CS centres.
Methods And Results:
Based on data from all CS patients treated in Germany from 2017-2021, the association between annual CS/MCS hospital volume and in-hospital mortality was assessed using adjusted Cox-regression, and spline plots were used to assess case thresholds. Overall, 220 223 CS patients underwent treatment at 1232 hospitals; 435/1232 (35%) of these performed MCS therapy, although only few hospitals (60/435, 14%) performed >25 MCS cases per year on average. Treatment at hospitals with a higher annual volume of CS and MCS cases was associated with a significantly lower mortality risk as compared to hospitals with a lower volume (upper third vs. lower two-thirds; CS: hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.91-0.94; p < 0.001; MCS: HR 0.80, 95% CI 0.76-0.84; p < 0.001). These associations were continuous without a detectable ceiling effect, with spline plots suggesting case thresholds of at least 90 CS cases/25 MCS cases per year.
Conclusions:
Care for patients with CS treated with and without MCS is associated with lower in-hospital mortality in hospitals that manage high volumes of CS and MCS. This analysis indicates that centralization of CS care in specialized centres treating high volumes of patients with CS and MCS might improve outcomes.
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