Optimizing cardiogenic shock outcomes: A system-based network approach

Cardiogenic shock (CS) is a life-threatening syndrome with persistently high mortality rates despite therapeutic advances. Structured regional networks may offer improved outcomes through standardized care and early advanced support.This study evaluates the impact of a structured regional cardiogenic shock network on in-hospital mortality and clinical outcomes.

We conducted a prospective observational study at the University Siena Hospital, enrolling CS patients (SCAI stage C-D-E) between September 2020 and November 2024. The study population was divided into patients directly admitted to the shock center (hub group) and those initially admitted to a referring network hospital (spoke group).

We enrolled 145 consecutive patients with CS (mean age 61.0 ± 14.2 years; 81.4% male), predominantly due to acute coronary syndrome (46.9%) or acute on chronic heart failure (32.4%). The majority (61.4%) were transferred from referring network regional hospitals. Despite a high-risk profile (SCAI stage D + E in 48.3%, phenotype II + III in 62.1%), 73.5% of patients achieved a successful outcome, defined as hospital discharge or cardiac replacement therapy (23 heart transplants, 9 LVADs). The overall in-hospital mortality was 26.5%. Mortality increased with SCAI stage (p = 0.001) according to literature data. A vaso-inotropic score (VIS score) major than 21 at 48 h after admission was predictive of mortality (AUC = 0.722).

In this observational study CS population presented low in-hospital mortality rate without any difference in hub and spoke group. It may be determined by the benefits of a structured regional network for CS and multidisciplinary approach management with early MCS implantation.