Cardiogenic shock (CS) treatment standardized across regional care networks has unclear advantages. The authors examined how patients with CS who presented to hub hospitals versus spoke hospitals within a regional care network were treated and what results they achieved. For their CS registry, the authors divided all patients who were added between January 2017 and December 2019 into 2 groups: those who presented to the hub hospital and those who presented to one of the spoke hospitals. The 30-day mortality rate was the main measure of success. Secondary objectives were secondary objectives of bleeding, stroke, and other serious adverse cardiovascular and cerebrovascular events. Of the total 520 CS patients, 286 (55%), or roughly half, were first seen at one of the 34 “spoke” hospitals. Patients at the spoke and hub locations were not significantly different in terms of demographic characteristics, including mean age (62 vs. 61 years; P=0.38), gender (25% vs. 32% women; P=0.10), or race (54% vs. 52% white; P=0.82). Slurred speech patients were more likely to have presented with acute myocardial infarction (50% vs. 32%; P<0.01), to have received vasopressors (74% vs. 66%; P=0.04), and to have received intra-aortic balloon pumps (88% vs. 37%; P<0.01). Patients in the hub group were more likely to receive veno-arterial extracorporeal membrane oxygenation (13% vs. 0%; P<0.01) and percutaneous ventricular assist devices (44% vs. 11%; P<0.01). Risk-adjusted 30-day mortality was not higher for patients who initially presented to a spoke (adjusted OR: 0.87 [95% CI: 0.49-1.55]; P=0.64), nor were rates of 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). Short-term outcomes for patients at the spokes and the hubs were similar within a regionalized CS network. Learning more about the most effective method for encouraging uniformity in care and better results across CS networks in different regions is important.
Source: sciencedirect.com/science/article/abs/pii/S2213177922002426
