Abstract 15718: Higher In-Hospital Mortality Among Cardiogenic Shock Patients With De Novo versus Acute on Chronic Heart Failure

Abstract

Introduction: Heart failure cardiogenic shock (HF-CS) constitutes a heterogenous population and has been identified as the leading type of shock among contemporary intensive care units. The in-hospital trajectory of shock severity and its association with mortality and transition to heart replacement therapy (HRT) or native heart survival (NHS) based on HF-CS phenotype has not been well described. Methods: The Cardiogenic Shock Working Group (CSWG) registry includes patients from 17 hospitals between 2016 and 2021. For this analysis, HF-CS patients were sub-classified as having de novo HF-CS or acute-on-chronic (ACHF) CS. In-hospital trajectories were assessed using baseline and maximum Society for Cardiovascular Angiography and Interventions (SCAI) stages and clinical outcomes were analyzed. Results: A total of 1,767 patients with HF-CS were included. Of these, 349 had de novo HF-CS (19.8%) and 1,371 (77.6%) had ACHF-CS. Overall, patients with de novo HF-CS had greater in-hospital death (32% vs 22%), NHS (58% vs 45%) and less HRT (33% vs 10%) when compared to ACHF-CS (all p<0.001). These variances in clinical outcomes differ when analyzed according to SCAI stages, with more significant differences between de novo HF-CS vs. ACHF-CS across baseline and maximum SCAI Stages C-D (Figure). Conclusions: Using a large contemporary real-world dataset of HF-CS, we identified that de novo HF-CS is associated with higher in-hospital mortality and NHS and lower HRT compared to ACHF-CS. These differences vary depending to SCAI Stage and are more pronounced in SCAI Stages C and D. Further efforts to define shock trajectories and to tailor therapeutics in HF-CS patients are urgently needed.