Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 18;25(1):402.
doi: 10.1186/s13054-021-03820-1.

Cardiogenic shock in Taiwan from 2003 to 2017 (CSiT-15 study)

Shih-Chieh Chien #  1   2 , Chien-Yi Hsu #  3   4 , Hung-Yi Liu  5 , Chao-Feng Lin  2 , Chung-Lieh Hung  2 , Chun-Yao Huang  3   4 , Li-Nien Chien  6   7
Affiliations

Cardiogenic shock in Taiwan from 2003 to 2017 (CSiT-15 study)

Shih-Chieh Chien et al. Crit Care. .

Abstract

Background: This study investigated temporal trends in the treatment and mortality of patients with cardiogenic shock (CS) in Taiwan in relation to acute myocardial infarction (AMI) accreditation implemented in 2009 and the unavailability of percutaneous ventricular assist devices.

Methods: Data of patients diagnosed as having CS between January 2003 and December 2017 were collected from Taiwan's National Health Insurance Research Database. Each case was followed from the date of emergency department arrival or hospital admission for the first incident associated with a CS diagnosis up to a 1-year interval. Measurements included demographics, comorbidities, treatment, mortality, and medical costs. Using an interrupted time-series (ITS) design with multi-level mixed-effects logistic regression model, we assessed the impact of AMI accreditation implementation on the mortality of patients with AMI and CS overall and stratified by the hospital levels.

Results: In total, 64 049 patients with CS (mean age:70 years; 62% men) were identified. The incidence rate per 105 person-years increased from 17 in 2003 to 25 in 2010 and plateaued thereafter. Average inpatient costs increased from 159 125 points in 2003 to 240 993 points in 2017, indicating a 1.5-fold increase. The intra-aortic balloon pump application rate was approximately 22-25% after 2010 (p = 0.093). Overall, in-hospital, 30-day, and 1-year mortality declined from 60.3%, 63.0%, and 69.3% in 2003 to 47.9%, 50.8% and 59.8% in 2017, respectively. The decline in mortality was more apparent in patients with AMI-CS than in patients with non-AMI-CS. The ITS estimation revealed a 2% lower in-hospital mortality in patients with AMI-CS treated in district hospitals after the AMI accreditation had been implemented for 2 years.

Conclusions: In Taiwan, the burden of CS has consistently increased due to high patient complexity, advanced therapies, and stable incidence. Mortality declined over time, particularly in patients with AMI-CS, which may be attributable to advancements in AMI therapies and this quality-improving policy.

Keywords: Acute myocardial infarction; Cardiogenic shock; Intra-aortic balloon pump; Medical costs; Mortality; Policy; Taiwan.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Annual incidence per 105 person-years and average medical costs of cardiogenic shock. The crude incidence increased from 2003 to 2010 and stabilized after 2010. Medical costs consistently increased over time
Fig. 2
Fig. 2
Annual in-hospital, 30-day, and 1-year mortality rate. The unadjusted in-hospital, 30-day, and 1-year mortality rates consistently declined from 60.3%, 63%, and 69.3% in 2003 to 47.9%, 50.8%, and 59.8% in 2017, respectively
Fig. 3
Fig. 3
a The unadjusted annual in-hospital mortality stratified by AMI etiology and b hospital level of the AMI-CS population. a Declines in annual mortality were observed in both groups. b The in-hospital mortality rate was the highest in patients treated in district hospitals and the lowest in those treated in medical centers. However, these differences decreased in the later period. AMI, acute myocardial infarction; CS, cardiogenic shock
See this image and copyright information in PMC

References

    1. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136(16):e232–e268. - PubMed
    1. Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J. 2019;40(32):2671–2683. doi: 10.1093/eurheartj/ehz363. - DOI - PubMed
    1. Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294(4):448–454. doi: 10.1001/jama.294.4.448. - DOI - PubMed
    1. Mebazaa A, Combes A, van Diepen S, Hollinger A, Katz JN, Landoni G, et al. Management of cardiogenic shock complicating myocardial infarction. Intensive Care Med. 2018;44(6):760–773. doi: 10.1007/s00134-018-5214-9. - DOI - PubMed
    1. Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol. 2018;107(4):287–303. doi: 10.1007/s00392-017-1182-2. - DOI - PubMed