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Un mayor volumen hospitalario se asocia con una menor mortalidad en pacientes con shock cardiogénico y soporte
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.
European journal of heart failure
|August 31, 2025
Resumen
Los centros de alto volumen de choque cardiogénico (CS) y apoyo circulatorio mecánico (MCS) reducen la mortalidad de los pacientes. La centralización de la atención de CS en instalaciones especializadas y de gran volumen puede mejorar los resultados de los pacientes.
Área de la Ciencia:
- Cardiología
- Medicina de cuidados intensivos
- Investigación en servicios de salud
Sus antecedentes:
- La mortalidad por shock cardiogénico (SC) sigue siendo alta, lo que requiere mejores estrategias de tratamiento.
- Se recomienda la centralización del tratamiento de CS en centros especializados con experiencia en apoyo circulatorio mecánico (MCS) para mejorar los resultados de los pacientes.
- Las instalaciones de atención médica de alto volumen pueden ofrecer atención estandarizada y superior para condiciones complejas como CS.
Objetivo del estudio:
- Analizar la asociación entre el volumen hospitalario de casos de choque cardiogénico (CS) y apoyo circulatorio mecánico (MCS) y las tasas de mortalidad hospitalaria en Alemania.
- Identificar los umbrales de casos potenciales para el tratamiento de CS y MCS que se correlacionan con una mejor supervivencia del paciente.
Principales métodos:
- Se utilizaron datos de todos los pacientes con esclerosis múltiple tratados en Alemania entre 2017 y 2021.
- Se utilizó un análisis de regresión de Cox ajustado para evaluar la relación entre el volumen hospitalario anual de CS/MCS y la mortalidad hospitalaria.
- Se utilizaron gráficos de spline para visualizar asociaciones continuas e identificar umbrales de casos.
Principales resultados:
- El tratamiento en hospitales con mayores volúmenes anuales de casos de CS y MCS se asoció significativamente con un menor riesgo de mortalidad hospitalaria.
- Se observó una asociación continua, sin un efecto de techo, lo que sugiere beneficios en volúmenes crecientes.
- Las parcelas de división indicaron umbrales de casos beneficiosos potenciales de al menos 90 casos de CS y 25 casos de MCS por año.
Conclusiones:
- La atención de los pacientes con esclerosis múltiple, con o sin esclerosis múltiple, demuestra una menor mortalidad hospitalaria en los centros de esclerosis múltiple y esclerosis múltiple de gran volumen.
- La centralización de la atención de CS en centros especializados que gestionan altos volúmenes de pacientes podría conducir a mejores resultados para los pacientes.
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