Phase-of-care mortality assessment in cardiogenic shock due to end-stage heart failure

Abstract

End-stage heart failure-related cardiogenic shock (HF-CS) is associated with high risk of short-term mortality, but the causes and mode of death in HF-CS have not been described. This study aimed to (i) describe the causes/modes of death in patients with HF-CS based on the phases-of-care (Rescue-Optimization-Stabilization-Exit therapy), analogous to the phase-of-care mortality analysis, and (ii) assess the impact of the introduction of a standardized team-based care. We included 120 consecutive patients with HF-CS who underwent temporary mechanical circulatory support. The introduction of standardized team-based care reduced mortality at 6 months (36/63 (57%) vs 17/57 (30%), p = 0.003), but did not alter the distribution of phase-of-care mortality. There were fewer deaths following heart transplantation/left ventricular assist device therapy with standardized team-based care (6% vs 28%, p = 0.067) may be clinically relevant.

Keywords

• cardiogenic shock
• heart failure
• heart transplantation
• mechanical circulatory support
• multi-organ failure