Fifteen‐Year Trends in Incidence of Cardiogenic Shock Hospitalization and In‐Hospital Mortality in the United States

Abstract

Background There is a lack of contemporary data on cardiogenic shock (CS) in‐hospital mortality trends. Methods and Results Patients with CS admitted January 1, 2004 to December 31, 2018, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in‐hospital mortality among the overall population and selected subgroups. Among a total of 563 949 644 hospitalizations during the period from January 1, 2004, to December 30, 2018, 1 254 358 (0.2%) were attributed to CS. There has been a steady increase in hospitalizations attributed to CS from 122 per 100 000 hospitalizations in 2004 to 408 per 100 000 hospitalizations in 2018 ( P trend <0.001). This was associated with a steady decline in the adjusted trends of in‐hospital mortality during the study period in the overall population (from 49% in 2004 to 37% in 2018; P trend <0.001), among patients with acute myocardial infarction CS (from 43% in 2004 to 34% in 2018; P trend <0.001), and among patients with non–acute myocardial infarction CS (from 52% in 2004 to 37% in 2018; P trend <0.001). Consistent trends of reduced mortality were seen among women, men, different racial/ethnic groups, different US regions, and different hospital sizes, regardless of the hospital teaching status. Conclusions Hospitalizations attributed to CS have tripled in the period from January 2004 to December 2018. However, there has been a slow decline in CS in‐hospital mortality during the studied period. Further studies are necessary to determine if the recent adoption of treatment algorithms in treating patients with CS will further impact in‐hospital mortality.

The landscape of cardiogenic shock: epidemiology and current definitions

“…There has been a steady increase from 122 cases of cardiogenic shock per 100000 hospitalizations in 2004 to 408 per 100,000 hospitalizations in 2018. Notably, a stable decline in the adjusted rates of in-hospital mortality were observed during the period of the study in the overall population (from 49% in 2004 to 37% in 2018) among patients with AMI-cardiogenic shock (from 43% in 2004 to 34% in 2018), and among patients with non-AMI cardiogenic shock (from 52% in 2004 to 37% in 2018) [16]. Across all age groups, women had a lower incidence of cardio-genic shock than men.…”

The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design

“…It remains the leading cause of inhospital morbidity and mortality following acute myocardial infarction (AMI), with short-term mortality rates exceeding 40% (1). Its prevalence is also increasing, as the number of hospitalizations attributed to CS have nearly tripled in the last fifteen years (2). It is also the second most common indication for admission to contemporary cardiac intensive care units (CICU's) (3).…”

The shock team: a multidisciplinary approach to early patient phenotyping and appropriate care escalation in cardiogenic shock

“…Studies demonstrate a steady, albeit gradual, improvement in CS outcomes [9 ▪ ,10,11]. While some of this effect can be attributed to increased access to early PCI, a rising prevalence of CS patients admitted to ICUs, improved outcomes across multiple CS phenotypes, and improving outcomes despite increasing patient acuity suggest improved disease recognition and an impact of standardized care pathways.…”