Ankeet S Bhatt1, David D Berg1, Erin A Bohula1, Carlos L Alviar2, Vivian M Baird-Zars1, Christopher F Barnett3, James A Burke4, Anthony P Carnicelli5, Sunit-Preet Chaudhry6, Lori B Daniels7, James C Fang8, Christopher B Fordyce9, Daniel A Gerber10, Jianping Guo1, Jacob C Jentzer11, Jason N Katz5, Norma Keller2, Michael C Kontos12, Patrick R Lawler13, Venu Menon14, Thomas S Metkus15, Jose Nativi-Nicolau8, Nicholas Phreaner7, Robert O Roswell16, Shashank S Sinha17, R Jeffrey Snell18, Michael A Solomon19, Sean Van Diepen20, David A Morrow21. 1. Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 2. New York University Langone Health, New York, New York. 3. Department of Cardiology, MedStar Washington Hospital Center, Washington, D.C. 4. Lehigh Valley Health Network, Allentown, Pennsylvania. 5. Division of Cardiology, Duke University, Durham, North Carolina. 6. St. Vincent Medical Group, St. Vincent Heart Center, Indianapolis, Indiana. 7. Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California. 8. University of Utah, Salt Lake City, Utah. 9. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. 10. Cardiovascular Division, Department of Medicine, Stanford University, Stanford, California. 11. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 12. Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia. 13. Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada. 14. Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, Ohio. 15. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 16. Lenox Hospital, Northwell Health, New York, New York. 17. Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia. 18. Rush University Medical Center, Chicago, Illinois. 19. Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland. 20. Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 21. Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: dmorrow@bwh.harvard.edu.
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.
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.
Authors: David D Berg; Erin A Bohula; Sean van Diepen; Jason N Katz; Carlos L Alviar; Vivian M Baird-Zars; Christopher F Barnett; Gregory W Barsness; James A Burke; Paul C Cremer; Jennifer Cruz; Lori B Daniels; Andrew P DeFilippis; Affan Haleem; Steven M Hollenberg; James M Horowitz; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; Jason Ng; Ryan Orgel; Christopher B Overgaard; Jeong-Gun Park; Nicholas Phreaner; Robert O Roswell; Steven P Schulman; R Jeffrey Snell; Michael A Solomon; Bradley Ternus; Wayne Tymchak; Fnu Vikram; David A Morrow Journal: Circ Cardiovasc Qual Outcomes Date: 2019-03
Authors: Erin A Bohula; Jason N Katz; Sean van Diepen; Carlos L Alviar; Vivian M Baird-Zars; Jeong-Gun Park; Christopher F Barnett; Gurjaspreet Bhattal; Gregory W Barsness; James A Burke; Paul C Cremer; Jennifer Cruz; Lori B Daniels; Andrew DeFilippis; Christopher B Granger; Steven Hollenberg; James M Horowitz; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; Jason Ng; Ryan Orgel; Christopher B Overgaard; Nicholas Phreaner; Robert O Roswell; Steven P Schulman; R Jeffrey Snell; Michael A Solomon; Bradley Ternus; Wayne Tymchak; Fnu Vikram; David A Morrow Journal: JAMA Cardiol Date: 2019-09-01 Impact factor: 14.676
Authors: James L Januzzi; Margaret F Prescott; Javed Butler; G Michael Felker; Alan S Maisel; Kevin McCague; Alexander Camacho; Ileana L Piña; Ricardo A Rocha; Amil M Shah; Kristin M Williamson; Scott D Solomon Journal: JAMA Date: 2019-09-17 Impact factor: 56.272
Authors: Shashank S Sinha; Carolyn M Rosner; Behnam N Tehrani; Aneel Maini; Alexander G Truesdell; Seiyon Ben Lee; Pramita Bagchi; James Cameron; Abdulla A Damluji; Mehul Desai; Shashank S Desai; Kelly C Epps; Christopher deFilippi; M Casey Flanagan; Leonard Genovese; Hala Moukhachen; James J Park; Mitchell A Psotka; Anika Raja; Palak Shah; Matthew W Sherwood; Ramesh Singh; Daniel Tang; Karl D Young; Timothy Welch; Christopher M O'Connor; Wayne B Batchelor Journal: Circ Heart Fail Date: 2022-05-05 Impact factor: 10.447