Despite recent medical advancements, cardiogenic shock (CS), characterized by the heart’s failure to deliver enough blood and oxygen to critical organs, continues to have high mortality rates. Prior studies have revealed substantial variations in the delivery of therapeutic clinical care for CS across hospitals, underscoring the need for more robust evidence to guide routine practice. In a recent study published in the Canadian Journal of Cardiology, researchers (including the CVC’s Dr. Sean van Diepen) sought to characterize how practices and clinical outcomes varied among patients admitted to cardiac intensive care units (CICUs) with CS in the United States and Canada.
The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated collaborative research network of American Heart Association Level 1 CICUs across the United States and Canada. Researchers analyzed registry data from 34 American and 8 Canadian centres within this network, collected between 2017 and 2022. The primary outcomes examined were differences in baseline clinical characteristics, the application of critical care monitoring and therapies, and all-cause in-hospital mortality between patients with CS admitted to CICUs in the United States versus Canada.
Among 23,299 patients admitted to CICUs, 19% experienced CS, with the distribution being predominantly in the United States (88%) compared to Canada (12%). The study revealed a more frequent use of several critical care interventions in American centres compared to Canadian centres. These included invasive hemodynamic monitoring (US: 80.8% vs Canada: 74.8%), vasoactive medications (US: 88.9% vs Canada: 82.1%), and temporary mechanical circulatory support (tMCS) (US: 39.4% vs Canada: 23.1%). Across both countries, the intra-aortic balloon pump was the most frequently employed tMCS device. Although the United States demonstrated a lower adjusted in-hospital mortality rate (29.4%) than Canada (37.1%), the researchers caution that randomized clinical trials are required to definitively establish the impact of these treatments.
The findings of this study underscore the value of developing robust, evidence-based treatment algorithms for CS management to standardize care and enhance outcomes in this high-risk patient population.
