TY - JOUR
T1 - EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS)
T2 - A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland
AU - Warren, Alex
AU - McCall, Philip
AU - Proudfoot, Alastair
AU - Gillon, Stuart
AU - Abu-Arafeh, Ahmad
AU - McKnight, Angus John
AU - Mudie, Rosemary
AU - Armstrong, David
AU - Tzolos, Evangelos
AU - Livesey, John Andrew
AU - Sinclair, Andrew
AU - Baston, Veronica
AU - Dalzell, Jonathan
AU - Owen, Deborah
AU - Fleming, Lucy
AU - Scott, Ian
AU - Puxty, Alex
AU - Lee, Matthew MY
AU - Walker, Fiona
AU - Hobson, Simon
AU - Campbell, Euan
AU - Kinsella, Michael
AU - McGinnigle, Eilidh
AU - Docking, Robert
AU - Price, Grant
AU - Ramsay, Alex
AU - Bauld, Richard
AU - Herron, Suzanne
AU - Lone, Nazir I
AU - Mills, Nicholas L
AU - Hartley, Louise
N1 - Publisher Copyright:
© The Intensive Care Society 2023.
PY - 2024/5
Y1 - 2024/5
N2 - Background: Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. Methods: We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. Results: In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. Conclusions: In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.
AB - Background: Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. Methods: We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. Results: In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. Conclusions: In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.
KW - cardiac critical care
KW - cardiac intensive care
KW - Cardiogenic shock
KW - epidemiology
KW - mechanical circulatory support
U2 - 10.1177/17511437231217877
DO - 10.1177/17511437231217877
M3 - Article
C2 - 38737313
AN - SCOPUS:85181200551
SN - 1751-1437
VL - 25
SP - 147
EP - 155
JO - Journal of the Intensive Care Society
JF - Journal of the Intensive Care Society
IS - 2
ER -