Over a 15-year period, crude in-ICU mortality for cardiogenic shock declined from 50% to 45% (difference -5.6%; 95% CI -7.7 to -3.5; P<0.001), despite patients becoming more critically ill.
Observational (n=19,416)
Yes
Between 1997 and 2012, the incidence of cardiogenic shock in ICUs increased and patients became more critically ill, yet in-ICU mortality significantly decreased.
Effect estimate: Difference -5.6% (95% CI -7.7 to -3.5)
Absolute Event Rate: 45% vs 50%
Absolute Risk Reduction: 5.6%
p-value: p=< 0.001
AIM: To address the paucity of data on the characteristics, outcome and temporal trends in mortality of cardiogenic shock (CS) patients admitted to intensive care units (ICUs) we examined key features, variations in mortality from CS, and predictors of death in ICU patients over the past 15 years. METHODS AND RESULTS: From the 1997-2012 database of the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) that prospectively collects data from ICUs in the greater Paris area, we determined temporal trends in the incidence of CS, patient outcomes Crude and Simplified Acute Physiology Score (SAPS)-II Standardized Mortality and predictors of in-ICU mortality. Of the 316 905 ICU admissions, 19 416 (6.1%) exhibited CS, with incidence increasing from 4.1% to 7.7% (P < 0.001). Over time, the age of admitted patients decreased by 2.7 years 95% confidence interval (CI), -2.0 to -3.4 and SAPS-II increased by 5.8% (95% CI 4.8-6.8) from 58.7 ± 25.3 to 64.5 ± 23.3 (P < 0.001). Crude in-ICU mortality declined from 50% to 45% (-5.6%; 95% CI -7.7 to -3.5) as SAPS-II Standardized ICU mortality rates decreased from 56.5% to 44.2% (P < 0.001). A more recent time-period was an independent correlate of decreased mortality in multivariate analyses. The decrease in mortality rate was more marked in patients with decompensated heart failure, cardiac arrest, or acute myocardial infarction. CONCLUSIONS: Patients with CS represent a greater proportion of patients admitted to ICUs over the past 15 years, having become younger but more critically ill. Although their mortality has decreased, suggesting improved overall patient management, it remains particularly high, warranting further research specifically focused on this population.
Puymirat et al. (Thu,) conducted a observational in Cardiogenic shock (n=19,416). Recent time period (1997-2012 trends) vs. Earlier time period was evaluated on Crude in-ICU mortality (Difference -5.6%, 95% CI -7.7 to -3.5, p=< 0.001). Over a 15-year period, crude in-ICU mortality for cardiogenic shock declined from 50% to 45% (difference -5.6%; 95% CI -7.7 to -3.5; P<0.001), despite patients becoming more critically ill.