TY - JOUR

T1 - Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock

AU - Sundermeyer, Jonas

AU - Kellner, Caroline

AU - Beer, Benedikt N

AU - Besch, Lisa

AU - Dettling, Angela

AU - Bertoldi, Letizia Fausta

AU - Blankenberg, Stefan

AU - Dauw, Jeroen

AU - Dindane, Zouhir

AU - Eckner, Dennis

AU - Eitel, Ingo

AU - Graf, Tobias

AU - Horn, Patrick

AU - Jozwiak-Nozdrzykowska, Joanna

AU - Kirchhof, Paulus

AU - Kluge, Stefan

AU - Linke, Axel

AU - Landmesser, Ulf

AU - Luedike, Peter

AU - Lüsebrink, Enzo

AU - Majunke, Nicolas

AU - Mangner, Norman

AU - Maniuc, Octavian

AU - Möbius Winkler, Sven

AU - Nordbeck, Peter

AU - Orban, Martin

AU - Pappalardo, Federico

AU - Pauschinger, Matthias

AU - Pazdernik, Michal

AU - Proudfoot, Alastair

AU - Kelham, Matthew

AU - Rassaf, Tienush

AU - Reichenspurner, Hermann

AU - Scherer, Clemens

AU - Schulze, Paul Christian

AU - Schwinger, Robert H G

AU - Skurk, Carsten

AU - Sramko, Marek

AU - Tavazzi, Guido

AU - Thiele, Holger

AU - Villanova, Luca

AU - Morici, Nuccia

AU - Winzer, Ephraim B

AU - Westermann, Dirk

AU - Gustafsson, Finn

AU - Schrage, Benedikt

N1 - © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - Humans

KW - Shock, Cardiogenic/etiology

KW - Heart Failure

KW - Prognosis

KW - Hospital Mortality

U2 - 10.1002/ejhf.3082

DO - 10.1002/ejhf.3082

M3 - Journal article

C2 - 37940139

VL - 26

SP - 432

EP - 444

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1567-4215

IS - 2

ER -