Cardiac arrest in patients with heart failure-related cardiogenic shock: results from an international, multicentre cohort study
J Sundermeyer, C Kellner, B N Beer, A Dettling, L Besch, M Kriz, P Kirchhof, S Blankenberg, H Thiele, I Eitel, C Scherer, N Mangner, A Proudfoot, D Westermann, B SchrageAbstract
Background
Heart failure–related cardiogenic shock (HF-CS) is the leading etiological subtype of CS, accounting for more than 50% of cases in contemporary registries. Within this CS subset, the impact of out-of-hospital cardiac arrest (OHCA) on clinical trajectories and outcomes remains insufficiently characterized.
Purpose
The aim of this study was to evaluate clinical characteristics and outcomes in patients with HF-CS with and without OHCA.
Methods
Patients with HF-CS treated at 16 tertiary-care centers across five countries between 2011 and 2021 were analyzed. To evaluate differences in clinical characteristics, 30-day mortality, and in-hospital complications, patients with and without OHCA were compared using multivariable logistic and Cox regression models, adjusted for age and sex.
Results
Among 1,024 patients with HF-CS, 395 (38.6%) presented with OHCA. The median age was 64 years (interquartile range [IQR] 52–75), 289 (28.2%) were female. At admission, median lactate was 5.0 mmol/L (IQR 2.6–8.6), and the baseline left ventricular ejection fraction was 20% (IQR 15-30). Among patients with OHCA, 233 (59.0%) presented with previously known HF (acute-on-chronic HF-CS), whereas 162 (41.0%) had no prior history of HF (de novo HF-CS). Overall, a prior history of HF was inversely associated with OHCA (OR 0.52, 95% CI 0.39–0.68; p<0.001), whereas ischemic cardiomyopathy alone was independently associated with increased odds of OHCA (OR 1.83, 95% CI 1.27–2.62; p=0.001). Higher lactate levels upon admission were more frequently associated with OHCA (OR 2.41, 95% CI 1.96–2.98; p<0.001). Patients with HF-CS and OHCA had an approximately 10% higher absolute 30-day mortality compared with those without OHCA (57.2% vs. 47.4%; adjusted hazard ratio 1.62, 95% CI 1.34–1.95, p<0.001, Figure 1). Patients with OHCA more frequently experienced hypoxic brain injury compared with those without OHCA (17.3% vs. 1.0%, p<0.001). Other in hospital complications, including ischemic and bleeding events, stroke and sepsis, were comparable between groups.
Conclusions
In this multicenter observational study, OHCA appears to represent a substantial risk modifier in patients with HF-CS. These findings call for external validation.