Title

De Novo vs Acute-on-Chronic Presentations of Heart Failure-Related Cardiogenic Shock: Insights from the Critical Care Cardiology Trials Network Registry

Authors

Ankeet S. Bhatt, Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
David D. Berg, Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Erin A. Bohula, Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Carlos L. Alviar, New York University Langone Health, New York, New York.
Vivian M. Baird-Zars, Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Christopher F. Barnett, Department of Cardiology, MedStar Washington Hospital Center, Washington, D.C.
James A. Burke MD, PhD, Lehigh Valley Health NetworkFollow
Anthony P. Carnicelli, Division of Cardiology, Duke University, Durham, North Carolina.
Sunit-Preet Chaudhry, St. Vincent Medical Group, St. Vincent Heart Center, Indianapolis, Indiana.
Lori B. Daniels, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California.
James C. Fang, University of Utah, Salt Lake City, Utah.
Christopher B. Fordyce, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Daniel A. Gerber, Cardiovascular Division, Department of Medicine, Stanford University, Stanford, California.
Jianping Guo, Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Jacob C. Jentzer, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Jason N. Katz, Division of Cardiology, Duke University, Durham, North Carolina.
Norma Keller, New York University Langone Health, New York, New York.
Michael C. Kontos, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
Patrick R. Lawler, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.
Venu Menon, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, Ohio.

Document Type

Article

Publication Date

10-1-2021

Publication Title

Journal of cardiac failure

E-ISSN

1532-8414

Department(s)

Cardiology Division

Keywords

cardiogenic shock, critical care cardiology, heart failure

Abstract

BACKGROUND: Heart failure-related cardiogenic shock (HF-CS) accounts for an increasing proportion of cases of CS in contemporary cardiac intensive care units. Whether the chronicity of HF identifies distinct clinical profiles of HF-CS is unknown. METHODS AND RESULTS: We evaluated admissions to cardiac intensive care units for HF-CS in 28 centers using data from the Critical Care Cardiology Trials Network registry (2017-2020). HF-CS was defined as CS due to ventricular failure in the absence of acute myocardial infarction and was classified as de novo vs acute-on-chronic based on the absence or presence of a prior diagnosis of HF, respectively. Clinical features, resource use, and outcomes were compared among groups. Of 1405 admissions with HF-CS, 370 had de novo HF-CS (26.3%), and 1035 had acute-on-chronic HF-CS (73.7%). Patients with de novo HF-CS had a lower prevalence of hypertension, diabetes, coronary artery disease, atrial fibrillation, and chronic kidney disease (all P < 0.01). Median Sequential Organ Failure Assessment (SOFA) scores were higher in those with de novo HF-CS (8; 25th-75th: 5-11) vs acute-on-chronic HF-CS (6; 25th-75th: 4-9, P < 0.01), as was the proportion of Society of Cardiovascular Angiography and Intervention (SCAI) shock stage E (46.1% vs 26.1%, P < 0.01). After adjustment for clinical covariates and preceding cardiac arrest, the risk of in-hospital mortality was higher in patients with de novo HF-CS than in those with acute-on-chronic HF-CS (adjusted hazard ratio 1.36, 95% confidence interval 1.05-1.75, P = 0.02). CONCLUSIONS: Despite having fewer comorbidities, patients with de novo HF-CS had more severe shock presentations and worse in-hospital outcomes. Whether HF disease chronicity is associated with time-dependent compensatory adaptations, unique pathobiological features and responses to treatment in patients presenting with HF-CS warrants further investigation.

Volume

27

Issue

10

First Page

1073

Last Page

1081

DOI

10.1016/j.cardfail.2021.08.014

PubMed ID

34625127

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