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Observational Study
. 2024 Feb;26(2):432-444.
doi: 10.1002/ejhf.3082. Epub 2023 Nov 23.

Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock

Jonas Sundermeyer  1   2 , Caroline Kellner  1   3 , Benedikt N Beer  1   2 , Lisa Besch  1   2 , Angela Dettling  1   2 , Letizia Fausta Bertoldi  4 , Stefan Blankenberg  1   2   3 , Jeroen Dauw  5 , Zouhir Dindane  6 , Dennis Eckner  7 , Ingo Eitel  2   8 , Tobias Graf  2   8 , Patrick Horn  9 , Joanna Jozwiak-Nozdrzykowska  10 , Paulus Kirchhof  1   2   3 , Stefan Kluge  11 , Axel Linke  6 , Ulf Landmesser  12 , Peter Luedike  13 , Enzo Lüsebrink  14 , Nicolas Majunke  10 , Norman Mangner  6 , Octavian Maniuc  15 , Sven Möbius Winkler  16 , Peter Nordbeck  15 , Martin Orban  14 , Federico Pappalardo  17 , Matthias Pauschinger  7 , Michal Pazdernik  18 , Alastair Proudfoot  19 , Matthew Kelham  19 , Tienush Rassaf  13 , Hermann Reichenspurner  2   20 , Clemens Scherer  14 , Paul Christian Schulze  16 , Robert H G Schwinger  21 , Carsten Skurk  12 , Marek Sramko  18 , Guido Tavazzi  22   23 , Holger Thiele  10 , Luca Villanova  24 , Nuccia Morici  25 , Ephraim B Winzer  6 , Dirk Westermann  26 , Finn Gustafsson  27 , Benedikt Schrage  1   2
Affiliations
Free article
Observational Study

Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock

Jonas Sundermeyer et al. Eur J Heart Fail. 2024 Feb.
Free article

Abstract

Aims: Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute-on-chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients with de novo and acute-on-chronic HF-CS.

Methods and results: In this international observational study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation and 30-day mortality, adjusted logistic/Cox regression models were fitted. Patients (n = 1030) with HF-CS were analysed, of whom 486 (47.2%) presented with de novo HF-CS and 544 (52.8%) with acute-on-chronic HF-CS. Traditional markers of CS severity (e.g. blood pressure, heart rate and lactate) as well as use of treatments were comparable between groups. However, patients with acute-on-chronic HF-CS were more likely to have a higher CS severity and also a higher mortality risk, after adjusting for relevant confounders (de novo HF 45.5%, acute-on-chronic HF 55.9%, adjusted hazard ratio 1.38, 95% confidence interval 1.10-1.72, p = 0.005).

Conclusion: In this large HF-CS cohort, acute-on-chronic HF-CS was associated with more severe CS and higher mortality risk compared to de novo HF-CS, although traditional markers of CS severity and use of treatments were comparable. These findings highlight the vast heterogeneity of patients with HF-CS, emphasize that HF chronicity is a relevant disease modifier in CS, and indicate that future clinical trials should account for this.

Keywords: Acute‐on‐chronic heart failure; Cardiogenic shock; De novo heart failure; Heart failure.

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References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022;24:4–131. https://doi.org/10.1002/ejhf.2333
    1. Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI Clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv 2019;94:29–37. https://doi.org/10.1002/ccd.28329
    1. Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. SCAI SHOCK stage classification expert consensus update: A review and incorporation of validation studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022;79:933–946. https://doi.org/10.1016/j.jacc.2022.01.018
    1. Schrage B, Becher PM, Goßling A, Savarese G, Dabboura S, Yan I, et al. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Fail 2021;8:1295–1303. https://doi.org/10.1002/ehf2.13202
    1. Berg DD, Bohula EA, Van Diepen S, Katz JN, Alviar CL, Baird‐Zars VM, et al. Epidemiology of shock in contemporary cardiac intensive care units. Circ Cardiovasc Qual Outcomes 2019;12:e005618. https://doi.org/10.1161/CIRCOUTCOMES.119.005618

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