5803Contemporary Trends of Incidence, Management and Outcomes of Non-acute Coronary Syndrome Associated Cardiogenic Shock: data from 2003 to 2011

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Introduction: Cardiogenic shock (CS) is a critical condition with high mortality and morbidity. Acute coronary syndrome (ACS) is the most common condition associated with cardiogenic shock and extensive literature exists with respect to ACS related cardiogenic shock (ACS-CS). However, very limited contemporary data exists related to non-ACS related cardiogenic shock (non-ACS-CS). Hence we analyzed nationwide inpatient sample databases to study the temporal changes in incidence, management and clinical outcomes of non-ACS-CS.

Methods: We identified all CS patients with age ≥18 years from 2003 to 2011. Among these, patients with ACS diagnosis were classified as ACS-CS patients while those without a diagnosis of ACS were considered as non-ACS-CS patients. Primary outcome was trend in non-ACS-CS, and secondary outcomes included in-hospital mortality and use of intra-aortic balloon pump (IABP).

Results: Of 642,290 cardiogenic shock patients, 39.7% (n=255,355) were non-ACS patients. Mean age was 66.2±15.8 years, 40.6% female and 76.8% whites. The three most common primary causes of hospitalization in non-ACS-CS patients were congestive heart failure, septicemia and acute respiratory failure. The most common preexisting clinical comorbidities were hypertension, diabetes, hyperlipidemia, chronic pulmonary disease and congestive heart failure, and their prevalence increased significantly from 2003 to 2011 (all p trend <0.001). The proportion of non-ACS-CS patients increased significantly from 31.1% to 47.4% (p trend <0.001). Overall inpatient mortality was 41.6%, which declined significantly over a span of 9 years from 52.5% to 37.7% (adjusted odds ratio/year, 0.92, 95% CI 0.92 to 0.93, p<0.001). The overall use of intra-aortic balloon pump was 11.9% that decreased significantly from 12.7% in 2003 to 10.9% in 2011 (adjusted odds ratio 0.96, 95% CI, 0.95 to 0.96, p<0.001). Also both mean length of stay and average cost of hospitalization increased significantly (p trend <0.001).

Conclusion: Hospitalizations of patients with non-ACS- CS have increased exponentially among US adults from 2003 to 2011. While the proportion of comorbid chronic diseases has increased, there has been an overall decline in hospital mortality. There is a wide scope for improvement of clinical outcomes in these critically ill patients, demanding better and clear management guidelines.




Cardiology | Medical Sciences | Medicine and Health Sciences


Department of Medicine, Cardiology Division

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