Encouraging Decline Seen in Death Rates of Cardiogenic Shock

A new population-based study describing decade-long trends in the incidence and hospital case-fatality rates for patients who developed cardiogenic shock during hospitalization for acute myocardial infarction (AMI) concluded that there has been a decline in death rates, but not incidence. The findings were published in the March 2016 issue of Circulation: Cardiovascular Quality and Outcomes.

Cardiogenic shock is a complication of AMI that remains the most common cause of mortality in patients hospitalized with AMI, despite improvements in the overall in-hospital prognosis associated with AMI.

Robert J. Goldberg, PhD, of the University of Massachusetts Medical School in Worcester, and colleagues followed a population of 5686 residents in central Massachusetts hospitalized with AMI at all 11 medical centers in Worcester, Massachusetts, during 6 biennial periods between 2001 and 2011. Patients did not have cardiogenic shock at the time of hospital presentation.

On average, 3.7% of these patients developed cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed cardiogenic shock was 41.4%. The odds of dying after cardiogenic shock (crude and adjusted) declined during the most recent study years: (47.1% dying in 2001/2003, 42% dying in 2005/2007, and 28.6% dying in 2009/2011).

The investigators said that increases in the use of evidence-based cardiac medications and interventional procedures paralleled the increasing hospital survival trends.

“These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock,” the authors wrote.

The researchers noted, however, that it is important to be cautious about deriving any causal inferences from their observations because of the potential for confounding by treatment indication in this nonrandomized study.

Future studies are needed to evaluate the efficacy of existing strategies for the prevention and management of cardiogenic shock during hospitalization for AMI, and the development of protocols to ensure the optimal utilization of effective treatment strategies.