Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock

Findings From the NCDR

Rashmee U. Shah, James A de Lemos, Tracy Y. Wang, Anita Y. Chen, Laine Thomas, Nadia R. Sutton, James C. Fang, Benjamin M. Scirica, Timothy D. Henry, Christopher B. Granger

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

BACKGROUND: Many patients with acute myocardial infarction (AMI) and cardiogenic shock survive hospitalization; little is known about their subsequent prognosis.

OBJECTIVES: This study sought to evaluate the associations between cardiogenic shock and post-discharge mortality and all-cause hospitalization among hospital survivors.

METHODS: We included patients ≥65 years of age with AMI from the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) who survived hospitalization and linked these patients with Medicare claims data. We used proportional hazards models to test the association between cardiogenic shock and outcomes, adjusting for patient and hospital characteristics. Hazard ratios (HRs) are reported for early (1 to 60 days) and late (61 to 365 days) post-discharge time periods.

RESULTS: Among 112,668 AMI survivors, 5% had cardiogenic shock during hospitalization. The rate of death was significantly higher among patients with cardiogenic shock at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%). After accounting for baseline characteristics, the risk of death remained higher for cardiogenic shock patients in the first 60 days after discharge (adjusted HR: 1.62; 95% confidence interval [CI]: 1.46 to 1.80), but was similar to nonshock patients thereafter (adjusted HR: 1.08 for days 61 to 365; 95% CI: 1.00 to 1.18). The rate of all-cause hospitalization or death was significantly higher among shock patients at 60 days (33.9% vs. 24.9%) and 1 year (59.1% vs. 52.3%). After adjustment, the risk of this outcome was also clustered in the first 60 days (adjusted HR: 1.28; 95% CI: 1.21 to 1.35) and was similar thereafter (adjusted HR: 0.95 for days 61 to 365; 95% CI: 0.89 to 1.01).

CONCLUSIONS: Hospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock.

Original languageEnglish (US)
Pages (from-to)739-747
Number of pages9
JournalJournal of the American College of Cardiology
Volume67
Issue number7
DOIs
StatePublished - Feb 23 2016

Fingerprint

Cardiogenic Shock
Myocardial Infarction
Hospitalization
Confidence Intervals
Survivors
Registries
Mortality
Medicare
Proportional Hazards Models
Shock
Guidelines

Keywords

  • cause of death
  • follow-up studies
  • heart failure
  • outcomes assessment
  • patient readmission
  • prognosis

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock : Findings From the NCDR. / Shah, Rashmee U.; de Lemos, James A; Wang, Tracy Y.; Chen, Anita Y.; Thomas, Laine; Sutton, Nadia R.; Fang, James C.; Scirica, Benjamin M.; Henry, Timothy D.; Granger, Christopher B.

In: Journal of the American College of Cardiology, Vol. 67, No. 7, 23.02.2016, p. 739-747.

Research output: Contribution to journalArticle

Shah, Rashmee U. ; de Lemos, James A ; Wang, Tracy Y. ; Chen, Anita Y. ; Thomas, Laine ; Sutton, Nadia R. ; Fang, James C. ; Scirica, Benjamin M. ; Henry, Timothy D. ; Granger, Christopher B. / Post-Hospital Outcomes of Patients With Acute Myocardial Infarction With Cardiogenic Shock : Findings From the NCDR. In: Journal of the American College of Cardiology. 2016 ; Vol. 67, No. 7. pp. 739-747.
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AU - Chen, Anita Y.

AU - Thomas, Laine

AU - Sutton, Nadia R.

AU - Fang, James C.

AU - Scirica, Benjamin M.

AU - Henry, Timothy D.

AU - Granger, Christopher B.

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N2 - BACKGROUND: Many patients with acute myocardial infarction (AMI) and cardiogenic shock survive hospitalization; little is known about their subsequent prognosis.OBJECTIVES: This study sought to evaluate the associations between cardiogenic shock and post-discharge mortality and all-cause hospitalization among hospital survivors.METHODS: We included patients ≥65 years of age with AMI from the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) who survived hospitalization and linked these patients with Medicare claims data. We used proportional hazards models to test the association between cardiogenic shock and outcomes, adjusting for patient and hospital characteristics. Hazard ratios (HRs) are reported for early (1 to 60 days) and late (61 to 365 days) post-discharge time periods.RESULTS: Among 112,668 AMI survivors, 5% had cardiogenic shock during hospitalization. The rate of death was significantly higher among patients with cardiogenic shock at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%). After accounting for baseline characteristics, the risk of death remained higher for cardiogenic shock patients in the first 60 days after discharge (adjusted HR: 1.62; 95% confidence interval [CI]: 1.46 to 1.80), but was similar to nonshock patients thereafter (adjusted HR: 1.08 for days 61 to 365; 95% CI: 1.00 to 1.18). The rate of all-cause hospitalization or death was significantly higher among shock patients at 60 days (33.9% vs. 24.9%) and 1 year (59.1% vs. 52.3%). After adjustment, the risk of this outcome was also clustered in the first 60 days (adjusted HR: 1.28; 95% CI: 1.21 to 1.35) and was similar thereafter (adjusted HR: 0.95 for days 61 to 365; 95% CI: 0.89 to 1.01).CONCLUSIONS: Hospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock.

AB - BACKGROUND: Many patients with acute myocardial infarction (AMI) and cardiogenic shock survive hospitalization; little is known about their subsequent prognosis.OBJECTIVES: This study sought to evaluate the associations between cardiogenic shock and post-discharge mortality and all-cause hospitalization among hospital survivors.METHODS: We included patients ≥65 years of age with AMI from the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines) who survived hospitalization and linked these patients with Medicare claims data. We used proportional hazards models to test the association between cardiogenic shock and outcomes, adjusting for patient and hospital characteristics. Hazard ratios (HRs) are reported for early (1 to 60 days) and late (61 to 365 days) post-discharge time periods.RESULTS: Among 112,668 AMI survivors, 5% had cardiogenic shock during hospitalization. The rate of death was significantly higher among patients with cardiogenic shock at 60 days (9.6% vs. 5.5%) and 1 year (22.4% vs. 16.7%). After accounting for baseline characteristics, the risk of death remained higher for cardiogenic shock patients in the first 60 days after discharge (adjusted HR: 1.62; 95% confidence interval [CI]: 1.46 to 1.80), but was similar to nonshock patients thereafter (adjusted HR: 1.08 for days 61 to 365; 95% CI: 1.00 to 1.18). The rate of all-cause hospitalization or death was significantly higher among shock patients at 60 days (33.9% vs. 24.9%) and 1 year (59.1% vs. 52.3%). After adjustment, the risk of this outcome was also clustered in the first 60 days (adjusted HR: 1.28; 95% CI: 1.21 to 1.35) and was similar thereafter (adjusted HR: 0.95 for days 61 to 365; 95% CI: 0.89 to 1.01).CONCLUSIONS: Hospital survivors of AMI who had cardiogenic shock have a higher risk of death and/or hospitalization during the first year after discharge. The risk is time-dependent and is clustered in the early post-discharge period, after which the prognosis is similar in patients with and without cardiogenic shock.

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