Association between pre-existing heart failure and in-hospital outcomes and management in admissions with cardiogenic shock.

Abstract

Background: Cardiogenic shock (CS) remains highly lethal despite advances in care. Preexisting heart failure (HF) is common in CS, but its effect on outcomes and management is unclear.

Research design and methods: Using the 2016-2019 National Inpatient Sample, we identified adults (≥18 years) hospitalized with CS and categorized them by presence of preexisting HF. The primary outcome was in-hospital mortality; secondary outcomes included pulmonary artery catheterization, mechanical circulatory support (MCS), renal replacement therapy, major bleeding, length of stay, and hospital charges. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital characteristics.

Results: Of 640,660 CS admissions, 65.4% had HF. They were older, had more comorbidities, and were more often treated in large urban teaching hospitals. HF was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.58; 95% CI 0.56-0.60; p < 0.001), but greater use of pulmonary artery catheterization (aOR 1.76), MCS (aOR 1.33), and renal replacement therapy (aOR 1.11). HF patients had longer stays (+1.6 days), higher charges (+$23,197), and less major bleeding (aOR 0.74; p < 0.001).

Conclusions: Preexisting HF is associated with a distinct CS phenotype, including lower in-hospital mortality and higher resource utilization, highlighting the need for phenotype-specific strategies and refined risk models in CS management.