Some heart attack
patients have a complication called cardiogenic shock, or very low blood pressure that lasts for more than 30 minutes. The condition results in inadequate circulation of blood throughout the body. Mechanical devices are often used to sustain blood pressure at a safe level.
published in the Journal of the American College of Cardiology
compared outcomes between heart attack patients who experienced cardiogenic shock and those who did not. The study found that shock patients have a higher risk of death or rehospitalization than non-shock patients in the first 60 days after discharge. By the end of the first year, however, the gap between the two groups narrows.
Researchers used data from the American College of Cardiology’s ACTION Registry-GWTG
linked with Centers for Medicare & Medicaid Services claims data. They examined records from 112,561 heart attack patients treated at 677 U.S. hospitals between January 2007 and September 2012. Of this group, almost 5% experienced cardiogenic shock during the initial hospitalization.
Researchers found that at 60 days, almost 34% of shock patients were rehospitalized or had died, compared with about 25% of non-shock patients. At the one-year mark, the difference was not as great: about 59% of shock patients were rehospitalized or had died, compared with about 52% of patients without shock.
After adjusting for patient characteristics, medical problems, hospital region and size, and in-hospital events and interventions, the study demonstrated that patients who survive to 60 days have similar outcomes, regardless of shock status. For both groups, factors associated with one-year mortality include older age, discharge to a skilled nursing facility, and the number of hospitalizations in the year before the heart attack.
Rashmee Shah, MD, the study’s lead author, notes that since outcomes between shock and non-shock patients were similar after 60 days, “there is a need to address the vulnerable immediate post-hospital period.” She said that “future investigations should identify reasons for this pattern so that interventions could be tailored to improve early survival and identify the sickest patients, who may be better served with palliative care or hospice.”