Abstract 13061: Trends in Incidence, Management and Outcomes of Heart Failure Patients with Cardiogenic Shock

Abstract

Background: Patients with heart failure who develop cardiogenic shock or have Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 profile have high mortality. However, trends in incidence, management and outcomes of these patients are not well defined. Methods: We analyzed patients in the Nationwide Inpatient Sample (NIS) between 2002-2011 with primary discharge diagnosis of Heart Failure (CHF) and secondary diagnosis of cardiogenic shock. Primary outcome was trend in cardiogenic shock complicating CHF. Secondary outcome was trends in in-hospital mortality. We excluded discharges with co-diagnosis of Acute Myocardial Infarction (AMI) from our analysis. Results: Among 10,475,927 weighted discharges with primary diagnosis of CHF, 349,292 discharges with AMI were eliminated. Of the remaining 10,126,635 discharges, cardiogenic shock was present in 56,314(0.6%). During the study period there was a steady increase in percentage of CHF patients with cardiogenic shock (0.4% in 2002 to 1.0% in 2011, p<0.001). Among patients with cardiogenic shock, the rates of heart transplant showed a steady increase from 2002 at 10.1% to peak in 2008 at 17.8% declining to 14.4% in 2011. Similarly, the rates of left ventricle assist device (LVAD) use showed a steady increase from 1% in 2002 to 11% in 2011. During the same period in-hospital mortality decreased from 44.2% to 26.1% (p<0.001). Conclusions: Cardiogenic shock complicating heart failure has a low but increasing incidence with time. There is a steady increase in the rates of heart transplant and LVAD use in these patients with a steady decline in in-hospital mortality over the ten-year period.