A Standardized and Regionalized Network of Care for Cardiogenic Shock,JACC: Heart Failure

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A Standardized and Regionalized Network of Care for Cardiogenic Shock
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2022-06-08 , DOI: 10.1016/j.jchf.2022.04.004
Behnam N Tehrani ₁ , Matthew W Sherwood ₁ , Carolyn Rosner ₁ , Alexander G Truesdell ₂ , Seiyon Ben Lee ₃ , Abdulla A Damluji ₁ , Mehul Desai ₁ , Shashank Desai ₁ , Kelly C Epps ₁ , Michael C Flanagan ₁ , Edward Howard ₂ , Nasrien Ibrahim ₁ , Jamie Kennedy ₁ , Hala Moukhachen ₁ , Mitchell Psotka ₁ , Anika Raja ₁ , Ibrahim Saeed ₂ , Palak Shah ₁ , Ramesh Singh ₁ , Shashank S Sinha ₁ , Daniel Tang ₁ , Timothy Welch ₁ , Karl Young ₁ , Christopher R deFilippi ₁ , Alan Speir ₁ , Christopher M O'Connor ₁ , Wayne B Batchelor ₁

Affiliation

Background

The benefits of standardized care for cardiogenic shock (CS) across regional care networks are poorly understood.

Objectives

The authors compared the management and outcomes of CS patients initially presenting to hub versus spoke hospitals within a regional care network.

Methods

The authors stratified consecutive patients enrolled in their CS registry (January 2017 to December 2019) by presentation to a spoke versus the hub hospital. The primary endpoint was 30-day mortality. Secondary endpoints included bleeding, stroke, or major adverse cardiovascular and cerebrovascular events.

Results

Of 520 CS patients, 286 (55%) initially presented to 34 spoke hospitals. No difference in mean age (62 years vs 61 years; P = 0.38), sex (25% vs 32% women; P = 0.10), and race (54% vs 52% white; P = 0.82) between spoke and hub patients was noted. Spoke patients more often presented with acute myocardial infarction (50% vs 32%; P < 0.01), received vasopressors (74% vs 66%; P = 0.04), and intra-aortic balloon pumps (88% vs 37%; P < 0.01). Hub patients were more often supported with percutaneous ventricular assist devices (44% vs 11%; P < 0.01) and veno-arterial extracorporeal membrane oxygenation (13% vs 0%; P < 0.01). Initial presentation to a spoke was not associated with increased risk-adjusted 30-day mortality (adjusted OR: 0.87 [95% CI: 0.49-1.55]; P = 0.64), bleeding (adjusted OR: 0.89 [95% CI: 0.49-1.62]; P = 0.70), stroke (adjusted OR: 0.74 [95% CI: 0.31-1.75]; P = 0.49), or major adverse cardiovascular and cerebrovascular events (adjusted OR 0.83 [95% CI: 0.50-1.35]; P = 0.44).

Conclusions

Spoke and hub patients experienced similar short-term outcomes within a regionalized CS network. The optimal strategy to promote standardized care and improved outcomes across regional CS networks merits further investigation.

中文翻译：

标准化和区域化的心源性休克护理网络

背景

跨区域护理网络对心源性休克 (CS) 进行标准化护理的好处知之甚少。

目标

作者比较了最初到区域护理网络内的中心医院和分支医院就诊的 CS 患者的治疗和结果。

方法

作者通过向轮辐医院和中心医院就诊，对在 CS 登记处登记的连续患者（2017 年 1 月至 2019 年 12 月）进行了分层。主要终点是 30 天死亡率。次要终点包括出血、中风或主要不良心脑血管事件。

结果

在 520 名 CS 患者中，286 名 (55%) 最初就诊于 34 家分支机构医院。辐射患者和中心患者之间的平均年龄（62 岁 vs 61 岁； P = 0.38）、性别（25% vs 32% 女性；P = 0.10）和种族（54% vs 52% 白人；P = 0.82）没有差异被注意到。Spoke 患者更常出现急性心肌梗塞（50% vs 32%；P < 0.01），接受血管升压药（74% vs 66%；P = 0.04）和主动脉内球囊反搏泵（88% vs 37%；P < 0.04 ） 0.01）。Hub 患者更常接受经皮心室辅助装置（44% vs 11%；P < 0.01）和动静脉体外膜氧合（13% vs 0%；P < 0.01）。初次就诊与风险调整后 30 天死亡率（调整后 OR：0.87 [95% CI：0.49-1.55]；P = 0.64）、出血（调整后 OR：0.89 [95% CI ： 0.49- 1.62]；P = 0.70）、中风（调整后 OR：0.74 [95% CI：0.31-1.75]；P = 0.49）或主要不良心脑血管事件（调整后 OR 0.83 [95% CI：0.50-1.35]；P = 0.44）。