Phase-of-care mortality assessment in cardiogenic shock due to end-stage heart failure

TL;DR

This study examines mortality causes in patients with heart failure-related cardiogenic shock and finds that team-based care reduces 6-month mortality but does not change the pattern of deaths across care phases.

Contribution

The study introduces a phase-of-care mortality analysis framework for cardiogenic shock and evaluates the impact of standardized team-based care.

Findings

Standardized team-based care reduced 6-month mortality from 57% to 30%.

Phase-of-care mortality distribution remained unchanged despite improved care.

Fewer deaths occurred after heart transplantation or LVAD therapy with team-based care.

Abstract

End-stage heart failure-related cardiogenic shock (HF-CS) is associated with high risk of short-term mortality, but the causes and mode of death in HF-CS have not been described. This study aimed to (i) describe the causes/modes of death in patients with HF-CS based on the phases-of-care (Rescue-Optimization-Stabilization-Exit therapy), analogous to the phase-of-care mortality analysis, and (ii) assess the impact of the introduction of a standardized team-based care. We included 120 consecutive patients with HF-CS who underwent temporary mechanical circulatory support. The introduction of standardized team-based care reduced mortality at 6 months (36/63 (57%) vs 17/57 (30%), p = 0.003), but did not alter the distribution of phase-of-care mortality. There were fewer deaths following heart transplantation/left ventricular assist device therapy with standardized team-based care (6% vs 28%, p = 0.067) may be clinically relevant.

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