Abstract 4364110: Etiology-Based Clinical and Economic Outcomes Among Hospitalizations for Cardiogenic Shock in the United States: An Analysis of the National Inpatient Sample

Abstract

Introduction: Cardiogenic shock (CS) remains a high-mortality condition with variable outcomes depending on underlying etiology. Common causes include acute coronary syndrome (ACS), decompensated heart failure, pulmonary embolism, myocarditis, and arrhythmias. Identifying differences in outcomes based on etiology may provide insight into risk stratification, resource allocation, and management strategies. Hypothesis: We hypothesized that in-hospital outcomes among CS patients differ significantly based on etiology, and that non-ACS causes exhibit variable risk profiles, resource needs, and discharge patterns compared to ACS-related CS. Methods: We analyzed adult hospitalizations with CS from 2016–2018 using the National Inpatient Sample (NIS) database. Patients were grouped into six mutually exclusive etiologies: ACS, cardiomyopathy, valvular, myocarditis, rhythm-related, and others. Patients with more than one CS etiology were excluded. Multivariable logistic and Cox regression models were used to compare outcomes across groups, adjusting for demographics and comorbidities. Kaplan-Meier survival curves were constructed to assess differences in survival across the etiological groups. Results: Among 37,039 CS hospitalizations, the most common etiologies were rhythm-related (36.6%), ACS (26.6%), and cardiomyopathy (20.5%). Compared to ACS, mortality was lower in cardiomyopathy (HR 0.704, 95% CI 0.660–0.751) and valvular CS (HR 0.839), and higher in rhythm (HR 1.274) and other CS (HR 1.201). Myocarditis showed no mortality difference (Figure 1). Cardiomyopathy-CS had increased AKI risk (OR 1.30), while all non-ACS groups except myocarditis had lower odds of sepsis (Figure 2). Myocarditis-CS had the highest use of Mechanical Circulatory Support (MCS) (OR 2.94); MCS use was significantly lower in cardiomyopathy, rhythm, and other etiologies (Figure 2). Stroke risk was highest in valvular-CS (OR 1.24); anoxic brain injury was most frequent in rhythm-CS (OR 1.44) (Figure 2). Cardiomyopathy-CS had the lowest hospital charges; myocarditis-CS had the highest when compared to ACS-CS (Figure 2). Conclusion: In this national analysis, in-hospital outcomes among patients with cardiogenic shock varied significantly by underlying etiology. Compared to ACS-related CS, non-ACS etiologies demonstrated distinct risk profiles and mortality outcomes. These findings underscore the importance of etiology-specific risk stratification and management strategies in CS.