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Invasive Hemodynamic Monitoring in Cardiogenic Shock Is Associated With Lower In‐Hospital Mortality

Osman, Mohammed; Syed, Moinuddin; Patel, Brijesh; Munir, Muhammad Bilal; Kheiri, Babikir; Caccamo, Marco; Sokos, George; Balla, Sudarshan; Basir, Mir Babar; Kapur, Navin K.; Mamas, Mamas A.; Bianco, Christopher M.

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Mohammed Osman

Moinuddin Syed

Brijesh Patel

Muhammad Bilal Munir

Babikir Kheiri

Marco Caccamo

George Sokos

Sudarshan Balla

Mir Babar Basir

Navin K. Kapur

Christopher M. Bianco


BackgroundThere is increasing utilization of cardiogenic shock treatment algorithms. The cornerstone of these algorithms is the use of invasive hemodynamic monitoring (IHM). We sought to compare the in‐hospital outcomes in patients who received IHM versus no IHM in a real‐world contemporary database.Methods and ResultsPatients with cardiogenic shock admitted during October 1, 2015 to December 31, 2018, were identified from the National Inpatient Sample. Among this group, we compared the outcomes among patients who received IHM versus no IHM. The primary end point was in‐hospital mortality. Secondary end points included vascular complications, major bleeding, need for renal replacement therapy, length of stay, cost of hospitalization, and rate of utilization of left ventricular assist devices and heart transplantation. Propensity score matching was used for covariate adjustment. A total of 394 635 (IHM=62 565; no IHM=332 070) patients were included. After propensity score matching, 2 well‐matched groups were compared (IHM=62 220; no IHM=62 220). The IHM group had lower in‐hospital mortality (24.1% versus 30.6%,P<0.01), higher percentages of left ventricular assist devices (4.4% versus 1.3%,P<0.01) and heart transplantation (1.3% versus 0.7%,P<0.01) utilization, longer length of hospitalization and higher costs. There was no difference between the 2 groups in terms of vascular complications, major bleeding, and the need for renal replacement therapy.ConclusionsAmong patients with cardiogenic shock, the use of IHM is associated with a reduction in in‐hospital mortality and increased utilization of advanced heart failure therapies. Due to the observational nature of the current study, the results should be considered hypothesis‐generating, and future prospective studies confirming these findings are needed.

Journal Article Type Article
Acceptance Date Jul 19, 2021
Online Publication Date Sep 13, 2021
Publication Date Sep 21, 2021
Publicly Available Date May 30, 2023
Journal Journal of the American Heart Association
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 10
Issue 18
Keywords Cardiology and Cardiovascular Medicine
Publisher URL