Key result
OHCA in HF-related cardiogenic shock is linked to ~62% higher 30-day mortality.
Why the study?
Does out-of-hospital cardiac arrest increase 30-day mortality and in-hospital complications in patients with heart failure-related cardiogenic shock?
Cohort (n=1,024)
Yes
Does out-of-hospital cardiac arrest increase 30-day mortality and in-hospital complications in patients with heart failure-related cardiogenic shock?
Out-of-hospital cardiac arrest is a major risk modifier in heart failure-related cardiogenic shock, associated with an approximately 10% higher absolute 30-day mortality and a significantly higher rate of hypoxic brain injury.
OHCA marks higher mortality and hypoxic brain injury risk in HF cardiogenic shock; leaves open whether targeted interventions improve outcomes.
Background Heart failure–related cardiogenic shock (HF-CS) is the leading etiological subtype of CS, accounting for more than 50% of cases in contemporary registries. Within this CS subset, the impact of out-of-hospital cardiac arrest (OHCA) on clinical trajectories and outcomes remains insufficiently characterized. Purpose The aim of this study was to evaluate clinical characteristics and outcomes in patients with HF-CS with and without OHCA. Methods Patients with HF-CS treated at 16 tertiary-care centers across five countries between 2011 and 2021 were analyzed. To evaluate differences in clinical characteristics, 30-day mortality, and in-hospital complications, patients with and without OHCA were compared using multivariable logistic and Cox regression models, adjusted for age and sex. Results Among 1,024 patients with HF-CS, 395 (38.6%) presented with OHCA. The median age was 64 years (interquartile range [IQR] 52–75), 289 (28.2%) were female. At admission, median lactate was 5.0 mmol/L (IQR 2.6–8.6), and the baseline left ventricular ejection fraction was 20% (IQR 15-30). Among patients with OHCA, 233 (59.0%) presented with previously known HF (acute-on-chronic HF-CS), whereas 162 (41.0%) had no prior history of HF (de novo HF-CS). Overall, a prior history of HF was inversely associated with OHCA (OR 0.52, 95% CI 0.39–0.68; p<0.001), whereas ischemic cardiomyopathy alone was independently associated with increased odds of OHCA (OR 1.83, 95% CI 1.27–2.62; p=0.001). Higher lactate levels upon admission were more frequently associated with OHCA (OR 2.41, 95% CI 1.96–2.98; p<0.001). Patients with HF-CS and OHCA had an approximately 10% higher absolute 30-day mortality compared with those without OHCA (57.2% vs. 47.4%; adjusted hazard ratio 1.62, 95% CI 1.34–1.95, p<0.001, Figure 1). Patients with OHCA more frequently experienced hypoxic brain injury compared with those without OHCA (17.3% vs. 1.0%, p<0.001). Other in hospital complications, including ischemic and bleeding events, stroke and sepsis, were comparable between groups. Conclusions In this multicenter observational study, OHCA appears to represent a substantial risk modifier in patients with HF-CS. These findings call for external validation.
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Sundermeyer et al. (2026) conducted a cohort in Heart failure-related cardiogenic shock (HF-CS) (n=1,024). Out-of-hospital cardiac arrest (OHCA) vs. No out-of-hospital cardiac arrest was evaluated on 30-day mortality (HR 1.62, 95% CI 1.34-1.95, p=<0.001). Out-of-hospital cardiac arrest in HF-related cardiogenic shock was associated with higher 30-day mortality vs no OHCA (57.2% vs 47.4%; adjusted HR 1.62, 95% CI 1.34-1.95; p<0.001).
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