Is Aggressive Management of Cardiogenic Shock Decreasing Deaths?

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Nonsignificant and inconsistent trends noted over time for incidence of cardiogenic shock
Nonsignificant and inconsistent trends noted over time for incidence of cardiogenic shock

HealthDay News — For patients who develop cardiogenic shock during hospitalization for acute myocardial infarction, the rates of death seem to have declined in recent years, according to research published online February 16 in Circulation: Cardiovascular Quality and Outcomes.

Robert J. Goldberg, PhD, from the University of Massachusetts Medical School in Worchester, and colleagues report on decade-long trends in the incidence and hospital case-fatality rates for patients who develop cardiogenic shock during hospitalization for acute myocardial infarction. Data were included for 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at 11 medical centers during six biennial periods between 2001 and 2011.

The researchers found that 3.7% of patients developed cardiogenic shock during their acute hospitalization; over time there were nonsignificant and inconsistent trends noted in crude (3.7% in 2011/2003, 4.5% in 2005/2007, and 2.7 percent in 2009/2011; P = 0.19) and multivariable-adjusted analyses. For patients who developed cardiogenic shock, the overall in-hospital case-fatality rate was 41.4 percent. During the most recent study years, the crude and multivariable-adjusted odds of dying after cardiogenic shock decreased (47.1 percent in 2001/2003, 42.0 percent in 2005/2007, and 28.6 percent in 2009/2011). The increasing trend in survival was paralleled by increases in use of evidence-based cardiac medications and interventional procedures.

"We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time," the authors write. "These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock."

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