Impact of hospital transfer to hubs on outcomes of cardiogenic shock in the real world

Lu, Daniel Y.; Adelsheimer, Andrew; Chan, Kee; Yeo, Ilhwan; Krishnan, Udhay; Karas, Maria; Horn, Evelyn M.; Feldman, Dmitriy N.; Sobol, Irina; Goyal, Parag; Bhatt, Reema; Batra, Supria; Sciria, Christopher; Olonoff, Danielle; Cheung, Jim W.; Kim, Luke K.

doi:10.1002/ejhf.2263

Cited by 30 publications

(23 citation statements)

References 26 publications

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“…In terms of clinical utility for clinical practice, a risk score model would ideally inform clinical decision‐making ( Figure ). The risk score should help to efficiently triage ‘selected patients’ to an appropriate care location, from ‘spoke’ to ‘hub’ hospitals, in order to facilitate specific interventions tailored to the aetiology and severity of CS 18,19 . Transferring patients who are too sick or out of the window of benefit may be futile, 4,18 while careful selection for transfer of targeted patients who may be potentially candidates for advanced therapies, may contribute to better outcomes.…”

Section: Figurementioning

confidence: 99%

Risk stratification in cardiogenic shock: from clinical utility to improving outcomes

Chioncel

Adamo

Bauersachs

2022

European J of Heart Fail

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Section: Figurementioning

confidence: 99%

Risk stratification in cardiogenic shock: from clinical utility to improving outcomes

Chioncel

Adamo

Bauersachs

2022

European J of Heart Fail

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“…However, in spite of limitations, the results of the current research suggest a clear signal of survival benefit for these critically ill patients when referred to a CS network with appropriate organization in terms of facilities, staff allocation, expertise and standardized protocols. Frequent training and quality improvement should be incorporated into CS teams to sustain adequate clinical and procedural proficiency 6,8 . Although, an accepted threshold for cost‐effectiveness has not been ‘politically specified’, the extensive resources needed to maintain CS teams require constant institutional administrative support, sufficient funding and staffing, and continuous documentation by cost‐effective analysis 6 .…”

Section: Figurementioning

confidence: 99%

“…Despite lower mortality, CS patients directly admitted or transferred to hub hospital had longer lengths of stay, higher rates of procedural-related complications such as major bleeding, stroke, vascular complications and acute kidney injury (AKI), and finally higher costs and higher 30-day readmissions. 8 In multivariable analysis, direct admission to a hub hospital [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.84-0.89] and interhospital transfer to a hub hospital (OR 0.72, 95% CI 0.69-0.76), revascularization with PCI or CABG and use of RHC were independently associated with significantly lower mortality. In contrast, MCS use and other index admission characteristics, such as acute myocardial infarction (AMI), cardiac arrest, mechanical ventilation, and AKI requiring dialysis, were associated with significantly higher mortality.…”

mentioning

confidence: 99%

“…In this issue of the Journal, Lu et al 8 presented the results of a post-hoc analysis aimed to describe baseline characteristics, treatment pattern and in-hospital outcomes of patients with CS stratified by type of hospital admission and transfer status. The authors used data from the Nationwide Readmissions Database (NRD) from 2010-2014 and identified a total of 412 667 hospitalizations for CS.…”

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confidence: 99%

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Cardiogenic shock centres for optimal care coordination and improving outcomes in cardiogenic shock

Chioncel

Metra

2021

European J of Heart Fail

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This article refers to 'Impact of hospital transfer to hubs on outcomes of cardiogenic shock in the real world' by D.Y. Lu et al., published in this issue on pages 1927-1937.Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult to the subsequent occurrence of organ failure and death. 1 Despite advanced management, including aetiological treatment and mechanical circulatory support (MCS), CS represents the most severe manifestation of acute heart failure 2 with in-hospital mortality varying between 30-50%, depending on the underlying aetiology. 1,3-5 CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested. Evidence from randomized trials is limited, mostly because small numbers of patients are recruited, with only approximately 2000 patients being randomized in CS trials. 4 In addition, blinding is often not possible, and the primary endpoints often differ among the studies. Furthermore, designing new outcome trials in CS remains particularly challenging in this critical and very costly scenario in cardiology. In these conditions, gaps in evidence are extensive in terms of disposition decisions, use of haemodynamic monitoring, and timely deployment of interventions. 1,[3][4][5] As a result of limited evidence base and inequal distribution of facilities there is a wide heterogeneity of patterns of care between the hospitals treating CS, which may delay timely deployment of appropriate resources or may delay the patient transfer to an experienced centre for haemodynamic support or definitive intervention. Recently, new approaches to care of CS patients have focused on mechanisms beyond medical therapies per se, implying that CS management should consider appropriate organization of the health care services in order to facilitate optimal care coordination and to minimize time delay. 6 There is growing interest for developing CS centres and CS teamsThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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“…showed that a regional 'hub-and-spoke' triage system, with direct admission to CS hubs or transfer to hubs, is associated with a lower mortality. 27 Mechanical circulatory support (MCS) may be useful in the management of CS. 26 However, data from randomized controlled trials (RCTs) seem not to reflect real-world practice.…”

Section: Cardiogenic Shockmentioning

confidence: 99%

November 2021 at a glance: focus on prevention, comorbidities, cardiogenic shock and novel devices

Tomasoni

Adamo

Metra

2021

European J of Heart Fail

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Imaging and heart failure preventionThe role of imaging in the management of heart failure (HF) is well established. [1][2][3] Less evidence is available regarding its role in HF prevention. The Copenhagen City Heart Study investigated the prognostic value of whole wall, endomyocardial, and epimyocardial global longitudinal strain (GLS) in the general population. In the sex-stratified analysis, whole wall and epimyocardial GLS were found to be significant predictors of prognosis in males, while no GLS parameter was useful in females. 4 Another study investigated the presence of subclinical congestion, assessed by three ultrasound (US) variables (inferior vena cava diameter, jugular vein distensibility ratio, the number of B-lines from a 28-point lung US), in patients with at least one risk factor for HF, including diabetes, ischaemic heart disease, and hypertension. Subclinical congestion was common and was described in 30% of subjects. Plasma natriuretic peptide concentrations were more closely related to left atrial volume than other US measures of congestion. 5

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Impact of hospital transfer to hubs on outcomes of cardiogenic shock in the real world

Abstract: Cardiogenic shock (CS) is associated with significant mortality, and there is a movement towards regional 'hub-and-spoke' triage systems to coordinate care and resources. Limited data exist on outcomes of patients treated at CS transfer hubs.

Cited by 30 publications

References 26 publications

Risk stratification in cardiogenic shock: from clinical utility to improving outcomes

Risk stratification in cardiogenic shock: from clinical utility to improving outcomes

Cardiogenic shock centres for optimal care coordination and improving outcomes in cardiogenic shock

November 2021 at a glance: focus on prevention, comorbidities, cardiogenic shock and novel devices

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