Need for Support: Facilitating Early Transfer of Cardiogenic Shock Patients to Advanced Heart Failure Centres

Abstract

Background

Cardiogenic shock (CS) is a complex, life-threatening condition that requires timely care of patients. The purpose of this study is to evaluate the characteristics and outcomes of patients transferred to a cardiac intensive-care unit from outside hospitals, compared to those of patients admitted directly to a CS centre.

Methods

Patients admitted with CS (January 1, 2014-December 31, 2019) were analyzed. Clinical characteristics and outcomes were recorded.

Results

A total of 916 patients were admitted with CS; 440 (48.0%) were transferred from outside hospitals, and 476 (52.0%) were admitted directly to our institution. Transferred patients were younger (56.5 ± 14.7 vs 63.3 ± 16.3 years, P < 0.001), required vasopressor support more often (63.6% vs 14.9%, P < 0.001), and required mechanical ventilation more often (40.6% vs 10.7%, P < 0.001) upon transfer to the cardiac intensive-care unit. Transferred patients more frequently required extracorporeal life support (8.9% vs 3.0%, P < 0.001), had a lower rate of requiring orthotopic heart transplantation (6.4% vs 14.6%, P < 0.001), and had a lower incidence of all-cause mortality during follow-up (52.3% vs 62.8%, P = 0.001). With a multivariate analysis, patients transferred from outside were found to be less likely to reach the composite endpoint of durable ventricular assist device, orthotopic heart transplantation, or death (hazard ratio 0.75, 95% confidence interval 0.62-0.90, P = 0.003).

Conclusions

Marked differences are present in the characteristics and outcomes of patients transferred from outside institutions vs of those transferred from within our quaternary-care centre. Further studies are required to evaluate decision-making for transfer of CS patients and assess CS outcomes in the setting of standardized CS protocols and interventions.