Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022

Wisam Al-Bassam; Samer Noaman; Rahul Kumar; Neil Glassford; Daryl Jones; Carys Jones; William Chan; David M Kaye; David Pilcher; Rinaldo Bellomo; Yehya Shehabi; Ary Serpa Neto

doi:10.1016/j.jcrc.2024.155001

Clinical outcomes of cardiogenic shock among critically ill patients admitted to intensive care units in Australia and New Zealand from 2003 to 2022

J Crit Care. 2024 Dec 16:86:155001. doi: 10.1016/j.jcrc.2024.155001. Online ahead of print.

Authors

Wisam Al-Bassam¹, Samer Noaman², Rahul Kumar³, Neil Glassford⁴, Daryl Jones⁵, Carys Jones⁶, William Chan², David M Kaye², David Pilcher⁷, Rinaldo Bellomo⁸, Yehya Shehabi⁹, Ary Serpa Neto¹⁰

Affiliations

¹ Monash Medical Centre, Victoria, Australia; Victorian Heart Hospital, Victoria, Australia; Monash University, Victoria, Australia. Electronic address: wisam.albassam@monashhealth.org.
² Department of Critical Care, Melbourne University, Victoria, Australia; Western Health, Victoria, Australia; Alfred Health, Victoria, Australia.
³ Royal Melbourne Hospital, Victoria, Australia.
⁴ Monash Medical Centre, Victoria, Australia; Victorian Heart Hospital, Victoria, Australia; Monash University, Victoria, Australia; Department of Critical Care, Melbourne University, Victoria, Australia; Austin Health, Victoria, Australia.
⁵ Monash University, Victoria, Australia; Department of Critical Care, Melbourne University, Victoria, Australia; Austin Health, Victoria, Australia.
⁶ Austin Health, Victoria, Australia.
⁷ Monash University, Victoria, Australia; Alfred Health, Victoria, Australia; The Australian & New Zealand Intensive Care Society (ANZICS) CORE, New Zealand.
⁸ Monash University, Victoria, Australia; Department of Critical Care, Melbourne University, Victoria, Australia; Royal Melbourne Hospital, Victoria, Australia; Austin Health, Victoria, Australia.
⁹ Monash Medical Centre, Victoria, Australia; Victorian Heart Hospital, Victoria, Australia; Monash University, Victoria, Australia.
¹⁰ Monash University, Victoria, Australia; Department of Critical Care, Melbourne University, Victoria, Australia; Austin Health, Victoria, Australia; The Australian & New Zealand Intensive Care Society (ANZICS) CORE, New Zealand; Hospital Israelita Albert Einstein, São Paulo, Brazil.

PMID: 39689378
DOI: 10.1016/j.jcrc.2024.155001

Abstract

Purpose: Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.

Methods: Retrospective study utilizing a large bi-national ICU database from 2003 to 2022. Patient characteristics and outcomes based on the ICU admission diagnosis of CS were evaluated and changes in outcomes over time after adjusting for key baseline variables were assessed.

Results: During the study period, among CS patients, there were significant reductions in severity of illness (APACHE III from 80 to 72 and Australian and New Zealand Risk of Death Scores from 0.34 to 0.30, both p < 0.001). There was also a significant increase in admissions from emergency departments (32 % to 41 %, p < 0.001). Over time, unadjusted hospital mortality decreased from 57 % in 2003 to 41 % in 2022 (P < 0.001). After adjustment for severity of illness, the odds ratios for hospital mortality also decreased to 0.49 (95 % CI, 0.38 to 0.64) compared with 2003 (p < 0.001).

Conclusions: Over twenty years period, among patients with CS admitted to ICU, there has been a significant change in the epidemiological characteristics and a decrease in absolute and adjusted mortality rates.

Keywords: Australia and New Zealand; Cardiogenic shock; ICU; Mortality.