A-1 Higher Mortality in Cardiogenic Shock Patients Transferred from a Referring Facility Compared to Patients Presenting to an Academic Medical Center
Mark Kaeppler, Eks W. Pollock, Kadam Patel, Mary Conti, Sergey Tarima, Mitchell Saltzberg, Soo Kim, Lucian Durham, David L. Joyce, Asim Mohammed
Medical College of Wisconsin, Milwaukee, WI, USA
Correspondence: Mark Kaeppler
Background: Cardiogenic shock (CS) is a highly fatal condition characterized by cardiac dysfunction leading to inadequate tissue perfusion. Few studies have sought to clarify the rate of mortality among different patient populations hospitalized with CS, and none have investigated CS patients transferred for a higher level of care.
Hypothesis: We hypothesized that transfer patients would experience a higher mortality rate compared to inpatients initially admitted to an academic medical center.
Methods: Studied patients were hospitalized at an academic medical center with an ICD-9/10 discharge diagnosis of CS between 12/2015 and 8/2017. A chart review identified admission status: to the academic medical center or transferred from a referring facility. Mortality was defined as death in the hospital or as a discharge to hospice. Patient characteristics stratified by admission status were compared. Univariate and multivariate logistic regression analysis were performed. All variables reported as significant had a two-sided p-value ≤0.01, unless otherwise stated.
Results: 508 patients were included in this analysis: 62% were male, 73% were Caucasian and mean age was 63 years. Presentation with STEMI was seen in 13% and ACS in 25% of patients. 31% of patients were transferred from another facility. Transfer patients had a higher rate of mortality than non-transfer patients (43.6% vs 33.5%, p=0.03). Univariate predictors of mortality included admission post cardiac arrest, respiratory failure, acute renal failure, need for dialysis, lower SBP or MAP and elevated direct bilirubin, lactic acid or creatinine. Multivariate regression analysis identified admission post cardiac arrest, respiratory failure, acute renal failure, need for dialysis and elevated lactic acid as predictors of mortality. Transfer status was not an independent predictor when adjusted for comorbidities.
Conclusion: In the study population, transfer patients have a higher severity of illness. This explains the increased mortality observed in this group, and indicates the need for early aggressive therapy in this population.