TY - JOUR
T1 - A Standardized and Regionalized Network of Care for Cardiogenic Shock
AU - Tehrani, Behnam N.
AU - Sherwood, Matthew W.
AU - Rosner, Carolyn
AU - Truesdell, Alexander G.
AU - Ben Lee, Seiyon
AU - Damluji, Abdulla A.
AU - Desai, Mehul
AU - Desai, Shashank
AU - Epps, Kelly C.
AU - Flanagan, Michael C.
AU - Howard, Edward
AU - Ibrahim, Nasrien
AU - Kennedy, Jamie
AU - Moukhachen, Hala
AU - Psotka, Mitchell
AU - Raja, Anika
AU - Saeed, Ibrahim
AU - Shah, Palak
AU - Singh, Ramesh
AU - Sinha, Shashank S.
AU - Tang, Daniel
AU - Welch, Timothy
AU - Young, Karl
AU - deFilippi, Christopher R.
AU - Speir, Alan
AU - O'Connor, Christopher M.
AU - Batchelor, Wayne B.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - cardiogenic shock
KW - hub and spoke networks
KW - systems of care
UR - http://www.scopus.com/inward/record.url?scp=85138071673&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138071673&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2022.04.004
DO - 10.1016/j.jchf.2022.04.004
M3 - Article
C2 - 36175063
AN - SCOPUS:85138071673
SN - 2213-1779
VL - 10
SP - 768
EP - 781
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 10
ER -