A Standardized and Regionalized Network of Care for Cardiogenic Shock

Behnam N. Tehrani, Matthew W. Sherwood, Carolyn Rosner, Alexander G. Truesdell, Seiyon Ben Lee, Abdulla A. Damluji, Mehul Desai, Shashank Desai, Kelly C. Epps, Michael C. Flanagan, Edward Howard, Nasrien Ibrahim, Jamie Kennedy, Hala Moukhachen, Mitchell Psotka, Anika Raja, Ibrahim Saeed, Palak Shah, Ramesh Singh, Shashank S. SinhaDaniel Tang, Timothy Welch, Karl Young, Christopher R. deFilippi, Alan Speir, Christopher M. O'Connor, Wayne B. Batchelor

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)768-781
Number of pages14
JournalJACC: Heart Failure
Issue number10
StatePublished - Oct 2022
Externally publishedYes


  • cardiogenic shock
  • hub and spoke networks
  • systems of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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