Impact of right heart failure in patients with cardiogenic shock

The prognosis of right heart failure (RHF) is purported to be poor, yet there are limited data detailing the implications of concomitant cardiogenic shock (CS) and RHF. We sought to characterize the prevalence and impact of RHF on patients with CS.

We queried the Vizient® Clinical Database to identify adults ≥18 years old admitted 1 October 2015 to 30 June 2023, with a diagnosis of CS. Using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidities, and markers of acuity, we compared in-hospital mortality between patients with and without a diagnosis of RHF as well as by Society of Cardiovascular Angiography and Interventions (SCAI) shock stages B through E. We identified 348 919 patients with CS, including 11.3% (n = 39 610) with RHF. Patients with RHF were younger (60.5 vs. 65.5; P < 0.001), more frequently had heart failure (HF) as their primary admission diagnosis (40.8% vs. 23.2%; P < 0.001), and presented in earlier SCAI shock stages. Patients with non-RHF CS were more likely to have acute myocardial infarction (AMI) as primary admission diagnosis (20.7% vs. 8.2%; P < 0.001) and present with out-of-hospital cardiac arrest (11.5% vs. 5.8%; P < 0.001). After adjustment, RHF was associated with a 2.4% [95% confidence interval (CI): 1.9-2.9%; P < 0.001] increase in absolute mortality and when stratified by SCAI shock stage. Patients with isolated RHF were found to have a higher absolute in-hospital mortality [9.8%; 95% (CI): 8.6-11.0%; P < 0.001].

The presence of RHF is associated with increased in-hospital mortality in patients admitted with CS.