Clinical impact of congestion in patients admitted for cardiogenic shock: A FRENSHOCK sub-analysis

Recent guidelines have proposed dichotomizing acute heart failure and cardiogenic shock (CS) phenotypes based on the presence of signs/symptoms of hypoperfusion/congestion. We aim to assess the clinical impact of congestion on prognosis in unselected CS. FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. Patients were classified as cold and wet or cold and dry according to congestive signs. Mortality at 30 days was analysed according to baseline phenotype. Among 593 CS patients with available pertinent data, 70.7% were male, with a median age of 67.0 (58.0–77.0) years, and 521 (87.9%) presented with congestion. Congestive patients had higher rates of prior cardiac disease (60.5% vs. 43.1%, P < 0.01) and chronic kidney disease (24.2% vs. 12.5%, P = 0.04). No differences were found regarding SCAI distribution and lactate levels. Congestion was associated with a significant increase in 30-day all-cause mortality (HR 1.99; 95% CI 1.05–3.78; P = 0.04), particularly among patients with persistent congestion after 24 hours of care (HR 2.29; 95% CI 1.20–4.36; P = 0.01) ( Fig. 1 ). Conversely, patients with resolved congestion at 24 hours had similar outcomes when compared to non-congestive patients (HR 0.76; 95% CI 0.31–1.88; P = 0.56). The detrimental impact of congestion was corroborated in a multivariate Cox regression analysis adjusted for baseline characteristics. Congestion and its persistence beyond 24 hours of management are frequent in patients with CS and are significantly associated with increased 30-day all-cause mortality. Further studies are warranted to clarify optimal strategies decongestion in CS patients.