Abstract 15831: Characterization of Patient-Specific Care Pathways in Cardiogenic Shock

• Published in: Circulation (New York, N.Y.) N.Y.), 2023-11, Vol.148 (Suppl_1)
• Main Authors: Saha, Amit, Beaini, Hadi, Godfrey, Sarah, Hall, Eric J, Truby, Lauren K, Hendren, Nicholas S, Thibodeau, Jennifer T, Hardin, Elizabeth A, Araj, Faris G, Hall, Hurst M, Grodin, Justin L, Drazner, Mark H, Farr, Maryjane A
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.148.suppl_1.15831

Abstract only Background: Heterogeneity in patient characteristics and clinical severity may affect treatment goals and associated management in cardiogenic shock (CS). We sought to better describe the development over time of specific care pathways and the associated patient phenotypes informing such decisions in CS. Methods: We consented and prospectively enrolled 60 patients presenting with CS from November 2022 to May 2023. Provider notes were reviewed for language describing 3 distinct care pathways: Advanced Group (AG): urgent evaluation for left ventricular assist device and/or heart transplantation; Recovery Group (RG): eligible for native myocardial recovery only; and Palliation Group (PG): unlikely to recover. Remaining patients were classified as No Decision (ND). Pathway decisions were assessed at days 3 and 7. Results: Median cohort age was 59 years (IQR 42-66), and 67% (n = 40) were men. Initial SCAI stages D and E comprised 63% (n = 38) of cases. By hospital days 3 and 7, care pathways were defined in 11 (18%) and 36 (60%) patients, respectively ( Figure ). There were no ND deaths before day 7. Patient characteristics were similar regardless of whether a pathway was specified by day 7. Across care pathways, recovery options decreased with increased age (AG 45, RG 53, PG 66 years; p = 0.037) and new dialysis requirement (AG 0%, RG 36% [n = 5], PG 56% [n = 5]; p = 0.007). Initial SCAI stage, CS etiology (AMI 20% [n = 12], HF 58% [n = 35]), rate of shock team activation (15% [n = 9]), and mechanical circulatory support use (43% [n = 26]) were numerically similar. Palliative care was involved in 78% (n = 47) of cases overall and in all PG cases. In-hospital mortality was 29% (n = 16) and was highest in PG (88.9% [n = 8], p