Implementation of shock teams and impact on the therapeutic approach and prognosis of cardiogenic shock in Spain.

内容摘要

There are no data on the implementation of shock teams (ST) or their impact on cardiogenic shock (CS) in Spain. We conducted a retrospective observational study including episodes of CS (2016-2022) from hospitals within the Spanish National Health System with availability of an Interventional Cardiology Unit. The population was divided into a) patients hospitalized in centers with ST (CS-ST) and b) patients hospitalized in centers without ST (CSNST). Furthermore, the availability of a cardiac intensive care unit (CICU), cardiac surgery, heart transplant program, and volume of CS cases at each center were recorded. The outcome variable was the in-hospital mortality rate. A total of 15,879 episodes were analyzed, 32% (5,095) of which corresponded to the CS-ST group. The proportion of&#xa0; enters with ST availability increased progressively from 7% in 2016 to 39% in 2022. Patients from the CS-ST group were younger (68 vs 71 years, P < .001) and more frequently underwent mechanical ventilation, renal replacement therapy, and circulatory support (P < .001), showing a higher rate of acute kidney failure and stroke and longer lengths of stay (12 days vs 9 days, P < .001). Care in centers with ST (OR, 0.86; 95% CI, 0.77-0.96; P = .005) and CICU (OR, 0.82; 95% CI, 0.69-0.98; P < .033) was significantly associated with a lower mortality rate. The availability of ST has expanded in our setting. Patients admitted to centers with ST are managed more invasively, with a lower in-hospital mortality rate despite a higher rate of complications. No existen datos sobre la implementaci&#xf3;n de equipos de shock (shock teams, ST) ni su impacto en el shock cardiog&#xe9;nico (SC) en Espa&#xf1;a. Se realiz&#xf3; un estudio observacional retrospectivo que incluy&#xf3; episodios de SC (2016-2022) de hospitales del Sistema Nacional de Salud con disponibilidad de unidad de cardiolog&#xed;a Intervencionista. La poblaci&#xf3;n se dividi&#xf3; en: a) pacientes hospitalizados en centros con ST (SC-ST) y b) pacientes hospitalizados en centros sin ST (SC-NST). Tambi&#xe9;n se registr&#xf3; la disponibilidad de unidad de cuidados intensivos cardiol&#xf3;gicos (UCIC), cirug&#xed;a cardiaca, programa de trasplante cardiaco y volumen de casos de SC de cada centro. La variable de resultado fue la mortalidad hospitalaria. Se analizaron 15.879 episodios, de los que el 32% (5.095) correspond&#xed;an al grupo SC-ST. El porcentaje de centros con disponibilidad de ST aument&#xf3; de forma progresiva desde el 7% en 2016 al 39% en 2022. Los pacientes del grupo SC-ST eran m&#xe1;s j&#xf3;venes (68 vs 71 a&#xf1;os, p < 0,001), y fueron tratados con mayor frecuencia con ventilaci&#xf3;n mec&#xe1;nica, depuraci&#xf3;n extrarrenal y soporte circulatorio (p < 0,001), presentaron mayor incidencia de fracaso renal agudo e ictus y tuvieron una mayor estancia hospitalaria (12 vs 9 d&#xed;as, p < 0,001). La asistencia en centros con ST (OR: 0,86; IC 95%: 0,77-0,96; p = 0,005) y UCIC (OR: 0,82; IC 95%: 0,69-0,98; p < 0,033) se asoci&#xf3; de forma significativa con una menor mortalidad. La disponibilidad de ST se ha extendido en Espa&#xf1;a. Los pacientes ingresados en centros con ST se manejan de forma m&#xe1;s invasiva, y tienen menor mortalidad hospitalaria a pesar de una mayor incidencia de complicaciones.