A Standardized and Regionalized Network of Care for Cardiogenic Shock

• Published in: JACC. Heart failure Vol. 10; no. 10; pp. 768 - 781
• Main Authors: Tehrani, Behnam N, Sherwood, Matthew W, Rosner, Carolyn, Truesdell, Alexander G, Ben Lee, Seiyon, Damluji, Abdulla A, Desai, Mehul, Desai, Shashank, Epps, Kelly C, Flanagan, Michael C, Howard, Edward, Ibrahim, Nasrien, Kennedy, Jamie, Moukhachen, Hala, Psotka, Mitchell, Raja, Anika, Saeed, Ibrahim, Shah, Palak, Singh, Ramesh, Sinha, Shashank S, Tang, Daniel, Welch, Timothy, Young, Karl, deFilippi, Christopher R, Speir, Alan, O'Connor, Christopher M, Batchelor, Wayne B
• Format: Journal Article
• Language: English
• Published: United States 01.10.2022
• Subjects: Female; Heart Failure; Heart-Assist Devices; Humans; Male; Middle Aged; Myocardial Infarction - therapy; Shock, Cardiogenic - therapy; Stroke - epidemiology; Stroke - therapy; systems of care; hub and spoke networks; cardiogenic shock
• ISSN: 2213-1779; 2213-1787
• DOI: 10.1016/j.jchf.2022.04.004

The benefits of standardized care for cardiogenic shock (CS) across regional care networks are poorly understood. The authors compared the management and outcomes of CS patients initially presenting to hub versus spoke hospitals within a regional care network. The authors stratified consecutive patients enrolled in their CS registry (January 2017 to December 2019) by presentation to a spoke versus the hub hospital. The primary endpoint was 30-day mortality. Secondary endpoints included bleeding, stroke, or major adverse cardiovascular and cerebrovascular events. Of 520 CS patients, 286 (55%) initially presented to 34 spoke hospitals. No difference in mean age (62 years vs 61 years; P = 0.38), sex (25% vs 32% women; P = 0.10), and race (54% vs 52% white; P = 0.82) between spoke and hub patients was noted. Spoke patients more often presented with acute myocardial infarction (50% vs 32%; P < 0.01), received vasopressors (74% vs 66%; P = 0.04), and intra-aortic balloon pumps (88% vs 37%; P < 0.01). Hub patients were more often supported with percutaneous ventricular assist devices (44% vs 11%; P < 0.01) and veno-arterial extracorporeal membrane oxygenation (13% vs 0%; P < 0.01). Initial presentation to a spoke was not associated with increased risk-adjusted 30-day mortality (adjusted OR: 0.87 [95% CI: 0.49-1.55]; P = 0.64), bleeding (adjusted OR: 0.89 [95% CI: 0.49-1.62]; P = 0.70), stroke (adjusted OR: 0.74 [95% CI: 0.31-1.75]; P = 0.49), or major adverse cardiovascular and cerebrovascular events (adjusted OR 0.83 [95% CI: 0.50-1.35]; P = 0.44). Spoke and hub patients experienced similar short-term outcomes within a regionalized CS network. The optimal strategy to promote standardized care and improved outcomes across regional CS networks merits further investigation.