Key result
Higher-volume cardiogenic shock centers are linked to ~8% lower in-hospital mortality.
Why the study?
Does treatment at high-volume centers reduce in-hospital mortality in patients with cardiogenic shock?
Cohort (n=220,223)
Yes
Does treatment at high-volume centers reduce in-hospital mortality in patients with cardiogenic shock?
Hazard Ratio: 0.92 (95% CI 0.91–0.94)
p-value: p=<0.001
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“Is it implanting early and helping support end-organ perfusion at a regional referral center, understanding that we’re going to be taking on a higher risk of adverse events during the transfer process? Or is it allowing for continued hypoperfusion so we can get the patient to a hub center, knowin...”
Treatment of cardiogenic shock at high-volume centers is associated with significantly lower in-hospital mortality, supporting the centralization of care.
Mortality for cardiogenic shock (CS) remains high. To improve outcomes, centralization of treatment in specialized centres, especially those with expertise in mechanical circulatory support (MCS), has been recommended. High-volume centres may be able to provide standardized, better care. We analysed associations between centre volume and outcomes in Germany, a large country with multiple types of CS centres. Based on data from all CS patients treated in Germany from 2017-2021, the association between annual CS/MCS hospital volume and in-hospital mortality was assessed using adjusted Cox-regression, and spline plots were used to assess case thresholds. Overall, 220 223 CS patients underwent treatment at 1232 hospitals; 435/1232 (35%) of these performed MCS therapy, although only few hospitals (60/435, 14%) performed >25 MCS cases per year on average. Treatment at hospitals with a higher annual volume of CS and MCS cases was associated with a significantly lower mortality risk as compared to hospitals with a lower volume (upper third vs. lower two-thirds; CS: hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.91-0.94; p < 0.001; MCS: HR 0.80, 95% CI 0.76-0.84; p < 0.001). These associations were continuous without a detectable ceiling effect, with spline plots suggesting case thresholds of at least 90 CS cases/25 MCS cases per year. Care for patients with CS treated with and without MCS is associated with lower in-hospital mortality in hospitals that manage high volumes of CS and MCS. This analysis indicates that centralization of CS care in specialized centres treating high volumes of patients with CS and MCS might improve outcomes.
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Dettling et al. (2025) conducted a cohort in Cardiogenic shock (n=220,223). Higher annual hospital volume of cardiogenic shock and mechanical circulatory support cases vs. Lower annual hospital volume was evaluated on In-hospital mortality (HR 0.92, 95% CI 0.91-0.94, p=<0.001). Treatment at hospitals with higher annual volumes of cardiogenic shock cases was associated with lower in-hospital mortality compared to lower volume centers (HR 0.92; 95% CI 0.91-0.94; p<0.001).
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