EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland

Alex Warren (Lead / Corresponding author), Philip McCall, Alastair Proudfoot, Stuart Gillon, Ahmad Abu-Arafeh, Angus John McKnight, Rosemary Mudie, David Armstrong, Evangelos Tzolos, John Andrew Livesey, Andrew Sinclair, Veronica Baston, Jonathan Dalzell, Deborah Owen, Lucy Fleming, Ian Scott, Alex Puxty, Matthew MY Lee, Fiona Walker, Simon HobsonEuan Campbell, Michael Kinsella, Eilidh McGinnigle, Robert Docking, Grant Price, Alex Ramsay, Richard Bauld, Suzanne Herron, Nazir I Lone, Nicholas L Mills, Louise Hartley

    Research output: Contribution to journalArticlepeer-review

    1 Citation (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)147-155
    Number of pages9
    JournalJournal of the Intensive Care Society
    Volume25
    Issue number2
    Early online date28 Dec 2023
    DOIs
    Publication statusPublished - May 2024

    Keywords

    • cardiac critical care
    • cardiac intensive care
    • Cardiogenic shock
    • epidemiology
    • mechanical circulatory support

    ASJC Scopus subject areas

    • Critical Care
    • Critical Care and Intensive Care Medicine

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