CANCARE RESEARCH
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An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Socioeconomic Disparities in Patients With Cardiogenic Shock Treated With Extracorporeal Support.
Clinical takeaway Higher neighborhood income was associated with lower in-hospital mortality among cardiogenic shock hospitalizations receiving VA-ECMO. These findings highlight socioeconomic disparities but do not establish their causes.
Summary & abstract
Study summary
This retrospective National Inpatient Sample study included 3,032 adult hospitalizations for cardiogenic shock treated with VA-ECMO during 2018–2022, examining ZIP code-level income and in-hospital mortality. Compared with the lowest-income quartile, the highest-income quartile had lower adjusted mortality risk (adjusted risk ratio 0.83; 95% confidence interval 0.74–0.94). Time-to-event analysis also showed a lower adjusted hazard of death for the highest versus lowest quartile (adjusted hazard ratio 0.76; 95% confidence interval 0.64–0.89). Mortality risk did not differ significantly between the second or third quartiles and the lowest quartile.
Study limitation: The retrospective design limits causal inference, and ZIP code-level income may not reflect individual socioeconomic circumstances.
Published abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a resource-intensive therapy that can be used in severe cardiogenic shock (CS). Socioeconomic factors are known determinants of cardiovascular outcomes, yet their association with mortality among patients receiving mechanical circulatory support remains unclear. We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample, including adult hospitalizations with CS receiving VA-ECMO between 2018 and 2022. Exposure was Zone Improvement Plan (ZIP) code-level median household income quartile. The primary outcome was in-hospital mortality. We used multivariable regression to estimate risk ratios and Cox-proportional hazards for time-to-event analyses, adjusting for confounders. The 3,032 hospitalizations were evenly distributed across income quartiles. Compared with the lowest-income quartile, the adjusted mortality risk ratio of the second (adjusted risk ratio [aRR], 0.97; 95% confidence interval [CI], 0.86-1.09) and third quartiles (aRR, 0.94; 95% CI, 0.84-1.05) had no significant difference. The highest-income quartile had a significantly lower risk of in-hospital mortality (aRR, 0.83; 95% CI, 0.74-0.94). Time-to-event analyses showed a lower adjusted hazard of death for the fourth versus first quartile (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.64-0.89), whereas second and third quartiles were not significantly different. These findings suggest that disparities persist among patients receiving resource-intensive life-support therapies, highlighting the need to measure socioeconomic variables and address structural factors influencing outcomes in critical care.
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Associated factors for in-hospital mortality in patients with fulminant myocarditis: a systematic review and meta-analysis.
Clinical takeaway These findings identify potential prognostic markers in fulminant myocarditis, but do not establish causality or treatment benefit. The immunoglobulin association is particularly fragile.
Summary & abstract
Study summary
This systematic review pooled 26 retrospective cohorts involving 4,890 patients with fulminant myocarditis to examine associations with all-cause in-hospital mortality. Cardiac arrest or CPR was associated with higher mortality odds (OR 2.57, 95% CI 1.49–4.44), while LVEF was inversely associated (OR 0.94, 95% CI 0.90–0.97). Age, lactate and cTnI also showed positive associations, while intravenous immunoglobulin therapy showed an inverse association. Evidence certainty was low for age and cTnI and very low for the other significant factors; lactate and immunoglobulin estimates were unstable in sensitivity analyses.
Study limitation: All included cohorts were retrospective, and most significant associations had very-low-certainty evidence.
Published abstract
BACKGROUND: Fulminant myocarditis (FM) progresses rapidly and carries high all-cause in-hospital mortality. Patients in the early phase often develop cardiogenic shock and malignant ventricular arrhythmias, with widely varying mortality rates reported across studies. Existing single-center cohorts yield conflicting prognostic findings with marked cross-cohort heterogeneity, and no standardized meta-analysis with GRADE certainty grading has been published to guide risk stratification. This meta-analysis pooled prognostic associations of all-cause in-hospital mortality in FM to inform acute risk evaluation and personalized care. METHODS: Eleven Chinese and English electronic databases were searched from database establishment through June 2025. Eligible studies were observational cohorts reporting prognostic associations of all-cause in-hospital mortality among FM patients. Two independent reviewers completed screening, data extraction and quality assessment separately. The Newcastle-Ottawa Scale (NOS) and AHRQ checklist were adopted to evaluate methodological quality. Pooled analyses were performed via the statsmodels package in Python, and the GRADE framework was applied to rate the certainty of evidence. RESULTS: 26 retrospective cohort studies with 4,890 FM patients were enrolled. Ten potential factors were meta-analyzed, of which six showed statistically significant associations with in-hospital mortality (P < 0.05), including age (OR = 1.03, 95% CI: 1.02-1.04), cardiac arrest or CPR (OR = 2.57, 95% CI: 1.49-4.44), lactate (OR = 1.08, 95% CI: 1.00-1.16), cTnI (OR = 1.04, 95% CI: 1.01-1.07), LVEF (OR 0.94, 95% CI 0.90-0.97), and intravenous immunoglobulin therapy (OR = 0.12, 95% CI: 0.02-0.86). CK-MB, serum creatinine, total bilirubin, and VT/VF showed no statistically significant association (all P > 0.05). GRADE evidence ratings indicated low-certainty evidence for age and cTnI, and very-low-certainty evidence for the remaining significant factors. Sensitivity analyses indicated unstable pooled estimates for lactate and intravenous immunoglobulin therapy. CONCLUSIONS: Four factors showed positive associations with elevated all-cause in-hospital mortality. LVEF was inversely associated with mortality, whereas the inverse association for IVIG represents a fragile treatment-related signal. These findings may inform acute risk screening, but most associations were supported by low or very low certainty evidence and should not be interpreted as causal. All included data were derived from retrospective cohorts. Standardized multicenter prospective studies are required to verify these prognostic associations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399446, identifier CRD420261399446.
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Disparities in the management of cardiogenic shock complicating acute myocardial infarction: a questionnaire survey in Beijing.
Clinical takeaway This survey identifies gaps in reported cardiogenic-shock infrastructure and monitoring across Beijing hospitals. It does not establish whether these differences affect patient outcomes.
Summary & abstract
Study summary
A questionnaire survey analyzed 142 Beijing hospitals to assess variation in care for cardiogenic shock complicating acute myocardial infarction. PCI capability was absent in 33.1% of hospitals, while 26.0% offered temporary or durable mechanical circulatory support. Pulmonary artery catheter monitoring was uncommon across hospital levels, and continuous lactate monitoring varied significantly between levels. Shock teams were available in 71.9% of Level 1 and 44.4% of Level 2 hospitals, while only 31.9% of Level 3 hospitals had established referral networks.
Study limitation: Hospital questionnaire responses describe reported practices rather than patient-level care; no patient outcomes were reported.
Published abstract
OBJECTIVE: To investigate disparities in the management of cardiogenic shock complicating acute myocardial infarction (AMI-CS) across different hospital levels in Beijing. METHODS: A standardized questionnaire was electronically distributed to 61 hospitals through the Beijing Cardiovascular Internal Medicine Quality Control and Improvement Center and the Beijing Extracorporeal Life Support Quality Control and Improvement Center. A multistage sampling method was also used to survey hospitals in eight Beijing districts that were not included in these quality control networks. Hospitals were categorized as Level 1 hospitals, Level 2 hospitals, or Level 3 hospitals according to international standards and the domestic context. RESULTS: A total of 142 hospitals were analyzed. All participating hospitals were capable of managing cardiovascular diseases. 33.1% of hospitals did not have percutaneous coronary intervention (PCI) capability; 40.8% provided only intra-aortic balloon pump and PCI, whereas 26.0% offered temporary or durable mechanical circulatory support. Level 3 hospitals often lacked established protocols for AMI-CS management. Level 1 hospitals (59.4%) and Level 2 hospitals (56.5%) were more likely to maintain a minimum mean arterial pressure target of 65 mmHg, whereas Level 3 hospitals more commonly accepted a lower target (45.5%). Pulmonary artery catheter monitoring was infrequently used across all hospital levels. Continuous lactate monitoring also differed significantly (Level 3, 39.1% vs. Level 2, 74.6% vs. Level 1, 84.4%; overall p < 0.001). Among the 61 hospitals participating in the quality control network, only 3.6% adopted the Society for Cardiovascular Angiography and Interventions shock stage classification. Shock teams were available in 71.9% of Level 1 hospitals and 44.4% of Level 2 hospitals. Furthermore, only 31.9% of Level 3 hospitals had established referral networks. CONCLUSION: Significant disparities exist in the diagnosis and management of AMI-CS across different hospital levels in Beijing. There is an urgent need to enhance the understanding and management of AMI-CS, especially in Level 2 and Level 3 hospitals.
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Time-Dependent Effects of Inotropic Exposure During Venoarterial Extracorporeal Membrane Oxygenation Support on the Probability of Extracorporeal Membrane Oxygenation Weaning Failure.
Clinical takeaway Greater cumulative inotropic exposure during VA ECMO was associated with worse outcomes, but this observational study does not establish that reducing inotropes improves recovery or survival.
Summary & abstract
Study summary
This observational cohort included 440 adults with severe cardiogenic shock receiving VA ECMO at six Dutch hospitals. ECMO weaning failure occurred in 235 patients (53.4%). This endpoint comprised death, ongoing ECMO support, or heart replacement therapy up to 30 days. In adjusted joint models, higher cumulative inotropic exposure was associated with greater risks of weaning failure (HR 1.04; 95% CI 1.00–1.07) and 30-day mortality (HR 1.04; 95% CI 1.01–1.08). Inotropic support remained largely unchanged in the days after VA ECMO initiation.
Study limitation: Residual confounding by illness severity and treatment indication may explain the associations; the abstract does not specify the exposure increment underlying hazard ratios.
Published abstract
OBJECTIVES: During venoarterial extracorporeal membrane oxygenation (VA ECMO), organ perfusion no longer entirely depends on native cardiac output, which may reduce the therapeutic advantage of inotropic drugs relative to their risks. We hypothesized that, in this setting, higher cumulative inotropic exposure would be associated with impaired cardiac recovery. DESIGN: Observational cohort study on the effects of longitudinal inotropic exposure during VA ECMO support. Temporal changes in inotropic support during VA ECMO support were evaluated. Cumulative inotropic exposure per day during VA ECMO support was calculated using the area under the curve of a standardized inotropic score. These cumulative inotropic scores were associated with the risk of ECMO weaning failure up to 30 days (a composite of death, ongoing need for ECMO support, or the need for heart replacement therapy), mortality, and complications, using joint modeling techniques. SETTING: Six hospitals in the Netherlands. PATIENTS: Adult patients with severe cardiogenic shock (CS) receiving VA ECMO support between 2018 and 2024. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Out of 440 patients with various causes of CS, 235 patients (53.4%) developed ECMO weaning failure. Inotropic support remained largely unchanged in the days following VA ECMO initiation. Adjusted joint models showed that a higher cumulative inotropic exposure during VA ECMO support was associated with an increased risk for ECMO weaning failure (hazard ratio [HR], 1.04; 95% CI, 1.00-1.07), 30-day mortality (HR, 1.04; 95% CI, 1.01-1.08), arrhythmias (HR, 1.05; 95% CI, 1.01-1.08), and protracted lactate clearance (HR, 0.96; 95% CI, 0.92-0.99). CONCLUSIONS: In patients requiring VA ECMO support for refractory CS, inotropic support is often maintained at similar levels after ECMO initiation. Higher cumulative inotropic exposure was associated with an increased risk for ECMO weaning failure. Prospective studies are needed to investigate whether inotropes can be tapered or even stopped and whether such a strategy could improve cardiac recovery.
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Mechanical circulatory support in hypertrophic cardiomyopathy with cardiogenic shock: A National Inpatient Sample analysis.
Clinical takeaway Temporary MCS use identified a high-mortality subgroup of obstructive HCM hospitalizations with cardiogenic shock. These observational findings do not establish that MCS caused harm or determine its comparative benefit.
Summary & abstract
Study summary
This retrospective National Inpatient Sample study examined adult obstructive hypertrophic cardiomyopathy hospitalizations complicated by cardiogenic shock during 2016–2022. Of 4,610 hospitalizations, 280 (6.1%) received temporary mechanical circulatory support, most commonly VA-ECMO. In-hospital mortality was 42.9% with support versus 22.0% without support; the adjusted association remained significant (adjusted odds ratio 2.88, 95% confidence interval 1.46–5.69). Support was also associated with higher hospital charges, but not significantly longer stays. The authors interpreted these associations as likely reflecting greater illness severity among patients selected for support rather than treatment-related harm.
Study limitation: Selection of more severely ill patients for MCS limits causal interpretation despite multivariable adjustment.
Published abstract
BACKGROUND: Cardiogenic shock in patients with obstructive hypertrophic cardiomyopathy (HCM) is highly lethal. Temporary mechanical circulatory support (MCS), including percutaneous ventricular assist devices such as Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), is increasingly used in refractory cardiogenic shock. However, data regarding outcomes in this population remain limited. METHODS: We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2022. All adult patients with obstructive HCM complicated by cardiogenic shock were included and stratified by temporary MCS use. Survey-weighted multivariable regression evaluated the association between MCS use and in-hospital mortality, length of stay, and total hospital charges. RESULTS: A total of 4610 obstructive HCM hospitalizations with cardiogenic shock were identified; 280 (6.1%) underwent temporary MCS, most commonly VA-ECMO. MCS recipients were younger (58.2 vs 64.6 years, p < 0.01) and less frequently female (46.4% vs 61.0%, p = 0.03). In-hospital mortality was higher with MCS (42.9% vs 22.0%, p < 0.01). After multivariable adjustment, MCS remained independently associated with in-hospital death (aOR 2.88, 95% CI 1.46-5.69) and with higher total hospital charges (adjusted β $391,783, 95% CI $173,936-$609,631), but not with length of stay (β 5.5 days, 95% CI -1.3 to 12.2). CONCLUSIONS: In obstructive HCM complicated by cardiogenic shock, temporary MCS was associated with higher in-hospital mortality and substantially higher resource utilization. These findings likely reflect the greater severity of illness among patients selected for MCS rather than treatment-related harm.
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Planned Versus Standby V-A ECMO Strategy During High-Risk PCI: A Retrospective Cohort Study.
Clinical takeaway This cohort suggests an association between planned ECMO and fewer in-hospital adverse events during elective high-risk PCI. The findings are hypothesis-generating rather than evidence establishing the superiority of either strategy.
Summary & abstract
Study summary
This single-center retrospective study compared planned versus standby V-A ECMO strategies in 74 patients undergoing elective high-risk PCI. Planned ECMO began before PCI; standby support was initiated only after predefined intraprocedural haemodynamic deterioration. In-hospital major adverse cardiac and cerebrovascular events occurred in 48.4% with standby versus 14.0% with planned support (p=0.002). Standby strategy remained associated with higher event odds after adjustment (adjusted OR 4.20; 95% CI 1.35–13.10) and longer ICU stays (8 versus 6 days). These associations do not establish a causal benefit from planned ECMO.
Study limitation: Nonrandomized allocation and few events limit causal inference; the abstract also reports inconsistent standby-group denominators.
Published abstract
BACKGROUND: The role of mechanical circulatory support (MCS) in high-risk percutaneous coronary intervention (HR-PCI) remains controversial, and the optimal timing of its initiation is not well defined. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides full hemodynamic support; however, comparative data on planned versus standby strategies are limited. AIM: To compare clinical outcomes of planned versus standby V-A ECMO support in patients undergoing elective HR-PCI, with a focus on the impact of timing of ECMO initiation. METHODS: This single-center retrospective observational study included 74 consecutive patients who underwent high-risk PCI between 2019 and 2025 and were managed according to a preprocedurally determined V-A ECMO strategy. Before PCI, the multidisciplinary Heart Team selected either a planned strategy (n = 43), in which V-A ECMO was initiated before PCI, or a standby strategy (n = 31), in which ECMO equipment and vascular access were prepared in advance, but ECMO was initiated only in response to predefined intraprocedural hemodynamic deterioration. The primary endpoint was in-hospital major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, myocardial infarction, stroke, and repeat revascularization. RESULTS: No statistically significant differences were observed in the measured baseline variables. ECMO support during PCI was required in 19/32 (61.3%) of patients in the standby-strategy group. The incidence of in-hospital MACCE was significantly higher in the standby-strategy group compared with the planned-strategy group (48.4% vs. 14.0%, p = 0.002). The standby-strategy group also had longer ICU stay (8 [5-12] vs. 6 [4-9] days, p = 0.03) and hospital stay (15 [11-20] vs. 12 [9-16] days, p = 0.02), as well as higher vasoactive-inotropic scores (p = 0.033). In multivariable analysis, the standby strategy was associated with higher odds of in-hospital MACCE after adjustment (adjusted OR, 4.20; 95% CI, 1.35-13.10; p = 0.013). CONCLUSIONS: In this single-center retrospective cohort of patients undergoing elective HR-PCI, a planned V-A ECMO strategy was associated with a lower incidence of in-hospital MACCE than a standby strategy. Given the nonrandomized treatment allocation, inclusion of standby patients who did not ultimately require ECMO, and limited number of events, these findings are hypothesis-generating and do not establish a causal benefit of planned ECMO or harm from rescue initiation.
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Corticosteroid therapy in cardiogenic shock: A systematic review and meta-analysis.
Clinical takeaway The available evidence does not establish whether corticosteroids affect acute mortality in cardiogenic shock. Potential adverse-outcome signals also remain highly uncertain.
Summary & abstract
Study summary
This systematic review compared corticosteroids with placebo or usual care in adults with cardiogenic shock. Eight studies were included, but the primary analysis comprised three observational studies of clearly defined cardiogenic shock. Unadjusted acute mortality showed no clear effect (risk ratio 1.05, 95% confidence interval 0.98–1.13), with high residual-confounding risk and very low evidence certainty. Weak evidence suggested increased hyperglycaemia and hospital-acquired infection, but definitions varied and certainty was very low. The authors concluded that evidence was insufficient to determine corticosteroids’ effect on acute mortality.
Study limitation: The primary analysis relied on three observational studies, with substantial clinical heterogeneity and high risk of residual confounding.
Published abstract
INTRODUCTION: Relative adrenal insufficiency and inflammation are associated with increased mortality in cardiogenic shock. In other shock states such as sepsis, guidelines recommend the administration of corticosteroids. METHODS: We conducted a pre-registered (CRD420251042819) systematic review and meta-analysis, searching MEDLINE, Embase and Cochrane Central on 21 June 2025. We included randomised controlled trials and observational studies of adult patients with cardiogenic shock which compared corticosteroids to placebo or usual care. The primary outcome was acute mortality. RESULTS: Of 3242 studies screened, eight studies (four randomised controlled trials and four observational cohort studies) were included with three observational studies of clearly-defined cardiogenic shock included in the primary analysis. There was substantial clinical heterogeneity across included studies of populations, interventions and observed mortality. Observational studies suggested between 7% and 29% of patients with cardiogenic shock received systemic corticosteroids. There was no evidence of an effect on acute mortality in unadjusted analysis (Risk Ratio = 1.05, 95% CI 0.98-1.13, p = 0.17), but there was high risk of residual confounding and a very low certainty of evidence. There was weak evidence of increased rates of hyperglycaemia and hospital-acquired infection, but this was defined heterogeneously and the certainty of evidence was very low. CONCLUSION: Our conclusions are limited by low study numbers, heterogeneity and uncertainty. There is insufficient evidence to determine the effect of corticosteroid use on acute mortality in cardiogenic shock. Further high-quality research is needed to assess the effect of corticosteroids on mortality in patients with cardiogenic shock.
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