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Naumann D, Fischer J, Gmeiner J, Lüsebrink E, Beer BN, Grieger M, Giousouf A, Schrage B, Stremmel C, Massberg S, Orban M, Scherer C. The association of off-hour vs. on-hour intensive care unit admission time with mortality in patients with cardiogenic shock: a retrospective multi-centre analysis. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:347-353. [PMID: 38306600 DOI: 10.1093/ehjacc/zuae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/04/2024]
Abstract
AIMS Studies have shown a so-called off-hour effect for many different diseases, but data are scarce concerning cardiogenic shock. We therefore assessed the association of off-hour vs. on-hour intensive care unit admission with 30-day mortality in patients with cardiogenic shock. METHODS AND RESULTS In total, 1720 cardiogenic shock patients (666 admitted during off-hours) from two large university hospitals in Germany were included in retrospect. An admission during off-hours was associated with increased 30-day mortality compared to an admission during on-hours [crude mortality 48% vs. 41%, HR 1.17 (1.03-1.33), P = 0.017]. This effect remained significant after propensity score matching (P = 0.023). Neither patients with a combined SCAI stage D and E (P = 0.088) or C (P = 0.548) nor those requiring cardiopulmonary resuscitation (P = 0.114) had a higher mortality at off-hour admission. In contrast, those without veno-arterial extracorporeal membrane oxygenation [HR 1.17 (1.00-1.36), P = 0.049], without acute myocardial infarction [HR 1.27 (1.02-1.56), P = 0.029] or a with combined SCAI stage A and B [HR 2.23 (1.08-4.57), P = 0.025] had an increased mortality at off-hour admission. CONCLUSION Our study showed an increased mortality in patients with cardiogenic shock admitted during off-hours, especially in those with a milder onset of disease. This stresses the importance of a thorough workup of each patient, especially at times of limited resources, the menace of underestimating the severity of cardiogenic shock, and the need for an improved 24×7 available risk stratification.
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Affiliation(s)
- Dominik Naumann
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Julius Fischer
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Jonas Gmeiner
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Hamburg/Lübeck/Kiel, Germany
| | - Maximilian Grieger
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Atakan Giousouf
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Hamburg/Lübeck/Kiel, Germany
| | - Christopher Stremmel
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
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Vallabhajosyula S, Rab ST. Heterogeneity in Cardiogenic Shock Presentation and Care: A Cautionary Tale. Chest 2024; 165:5-6. [PMID: 38199735 DOI: 10.1016/j.chest.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Saraschandra Vallabhajosyula
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Lifespan Cardiovascular Institute, Providence, RI.
| | - Syed Tanveer Rab
- Department of Medicine,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
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