Normal view MARC view ISBD view

Clinical Presentation and In-Hospital Trajectory of Heart Failure and Cardiogenic Shock.

MedStar author(s):

Citation: JACC Heart Failure. 2022 Oct 31PMID: 36342421Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2022 ISSN:

2213-1779

Name of journal: JACC. Heart failureAbstract: BACKGROUND: Heart failure-related cardiogenic shock (HF-CS) remains an understudied distinct clinical entity.CONCLUSIONS: In a large contemporary HF-CS cohort, we identified a greater incidence of in-hospital death and cardiac arrest as well as a more rapid escalation to maximum SCAI stage severity among DNHF-CS. AMCS use in HF-CS was common, with significant heterogeneity among device types. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483). Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: The Cardiogenic Shock Working Group registry includes patients with CS, regardless of etiology, from 17 clinical sites enrolled between 2016 and 2020. Patients with HF-CS (non-acute myocardial infarction) were analyzed and classified based on clinical presentation, outcomes at discharge, and shock severity defined by SCAI stages.OBJECTIVES: The authors sought to profile a large cohort of patients with HF-CS focused on practical application of the Society of Cardiovascular Angiography & Cardiovascular Interventions (SCAI) staging system to define baseline and maximal shock severity, in-hospital management with acute mechanical circulatory support (AMCS), and clinical outcomes.RESULTS: A total of 1,767 patients with HF-CS were included, of whom 349 (19.8%) had de novo HF-CS (DNHF-CS). Patients were more likely to present in SCAI stage C or D and achieve maximum SCAI stage D. Patients with DNHF-CS were more likely to experience in-hospital death and in- and out-of-hospital cardiac arrest, and they escalated more rapidly to a maximum achieved SCAI stage, compared to patients with acute-on-chronic HF-CS. In-hospital cardiac arrest was associated with greater in-hospital death regardless of clinical presentation (de novo: 63% vs 21%; acute-on-chronic HF-CS: 65% vs 17%; both P < 0.001). Forty-five percent of HF-CS patients were exposed to at least 1 AMCS device throughout hospitalization.All authors: Abraham J, Baca P, Blumer V, Burkhoff D, Dieng F, Garan AR, Guglin M, Hall S, Harwani NM, Hernandez-Montfort J, Hickey G, Kanwar M, Kapur NK, Kataria R, Khalife W, Kim J, Li B, Li S, Mahr C, Nathan S, Pahuja M, Schwartzman A, Sinha SS, Thayer KL, Vorovich E, Wencker D, Whitehead EH, Yin M, Zhang YFiscal year: FY2023 Digital Object Identifier:

https://dx.doi.org/10.1016/j.jchf.2022.10.002

Date added to catalog: 2022-12-13

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	36342421	Available		36342421

BACKGROUND: Heart failure-related cardiogenic shock (HF-CS) remains an understudied distinct clinical entity.

CONCLUSIONS: In a large contemporary HF-CS cohort, we identified a greater incidence of in-hospital death and cardiac arrest as well as a more rapid escalation to maximum SCAI stage severity among DNHF-CS. AMCS use in HF-CS was common, with significant heterogeneity among device types. (Cardiogenic Shock Working Group Registry [CSWG]; NCT04682483). Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: The Cardiogenic Shock Working Group registry includes patients with CS, regardless of etiology, from 17 clinical sites enrolled between 2016 and 2020. Patients with HF-CS (non-acute myocardial infarction) were analyzed and classified based on clinical presentation, outcomes at discharge, and shock severity defined by SCAI stages.

OBJECTIVES: The authors sought to profile a large cohort of patients with HF-CS focused on practical application of the Society of Cardiovascular Angiography & Cardiovascular Interventions (SCAI) staging system to define baseline and maximal shock severity, in-hospital management with acute mechanical circulatory support (AMCS), and clinical outcomes.

RESULTS: A total of 1,767 patients with HF-CS were included, of whom 349 (19.8%) had de novo HF-CS (DNHF-CS). Patients were more likely to present in SCAI stage C or D and achieve maximum SCAI stage D. Patients with DNHF-CS were more likely to experience in-hospital death and in- and out-of-hospital cardiac arrest, and they escalated more rapidly to a maximum achieved SCAI stage, compared to patients with acute-on-chronic HF-CS. In-hospital cardiac arrest was associated with greater in-hospital death regardless of clinical presentation (de novo: 63% vs 21%; acute-on-chronic HF-CS: 65% vs 17%; both P < 0.001). Forty-five percent of HF-CS patients were exposed to at least 1 AMCS device throughout hospitalization.

English