Predictors of poor outcomes in non-ischemic cardiogenic shock and the use of hospice in this population
Do A, Curran K, Hughes C, Solomon R, and Williams CT. Predictors of poor outcomes in non-ischemic cardiogenic shock and the use of hospice in this population. Journal of the American College of Cardiology 2020; 75(11):822.
J Am Coll Cardiol
Background Non-ischemic cardiomyopathy is under-appreciated in terms of both research and literature when compared to its ischemic counterpart. Not much is known about this vulnerable population. Therefore, we sought to identify clinical characteristics associated with poor outcomes amongst non-ischemic cardiogenic shock (NICS). Methods A retrospective chart review of NICS patients who were admitted to a tertiary transplant center from 6/2013 to 7/2018. T-test for continuous and chi-square tests for categorical data were used. Univariate analysis and multivariate regression models were used to analyze outcomes. Results Among 192 patients, 71.4% male, mean age of 57 ± 15, 47.9% white. Compared to the non-supported group, left ventricular assist device (62.5% vs 22.8%, p < 0.0001), Veno-arterial extracorporeal membrane oxygenation (62.5% vs 22.8%, p = 0.11), Intra- aortic balloon pump (IABP) (58.8% vs 21.1%, p = 0.0006) had significantly prolonged length of stay (LOS) which were defined as ≥ 20 days. Higher risks of hospital death were associated with age (OR 1.033, CI 1.002-1.064, p = 0.034) and IABP (OR 4.4, CI 1.4-14.5, p = 0.011). When combing all data, older mean age (58 years old vs 51 years old, p = 0.045), prior dialysis (100% vs 86.3%, p = 0.026), and inotrope usage (91% vs 80%, p = 0.011) were associated with the composite poor outcomes. Only 42 patients (22%) received hospice consultation during hospitalization. Hospice were consulted more for black patients (black 32.5% vs white 15.2%, p = 0.009). Conclusion In patients presenting with NICS, older age, prior dialysis, usage of inotropes were predictors of overall poor outcome. Mechanical circulatory support did not shorten inpatient LOS. Surprisingly, we did not identify any factors that increased the risk of readmission. Older age and IABP seemed to have higher inpatient mortality rate. Hospice was significantly underused in practice, especially in Caucasians. Future studies such as directly comparing non-ischemic and ischemic cardiomyopathy are needed to further understand NICS.