Background:Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular disease and chronic kidney disease, but with conflicting estimates. We aimed to quantify the association of COPD and incident cardiovascular diseases, chronic kidney disease and death. Methods:In this systematic review and meta-analysis, we searched MEDLINE and Embase for case-control studies reporting associations between COPD and cardiovascular diseases, chronic kidney disease and death from database inception until 15 April 2026. Two reviewers independently extracted study characteristics and reported risk ratios of incident outcomes associated with COPD, specifically: atrial fibrillation and flutter, ventricular fibrillation and tachycardia, myocardial infarction, ischaemic stroke, heart failure, peripheral arterial disease, chronic kidney disease, cardiovascular mortality and all-cause mortality. Pooled estimates were obtained using random-effects models with restricted maximum likelihood estimation as substantial heterogeneity was anticipated. Ten sensitivity analyses stratifying studies by design, follow-up duration, region, clinical context, sample size, publication date, COPD ascertainment, leave-one-out, ratio adjustment and risk of bias, subgroup analyses by age and risk group were undertaken, and subsequent univariate and multivariate meta regression was performed. Study quality was assessed using the risk of bias in non-randomised follow-up studies of exposure effects (ROBINS-E) tool, and certainty of evidence was assessed using Grading of Assessment, Evaluation, Development and Evaluation (GRADE) criteria. Risk of publication bias was assessed using funnel plots and Egger's regression. This review was registered on PROSPERO (CRD42025639084). Findings:Of 140 case-control studies including 30,144,481 patients (3,062,712 with COPD) with median follow -up duration of 3.0 years (IQR 1.0-5.2), COPD was associated with increased risk of heart failure (risk ratio [RR] 2.33, 95% CI 1.78-3.06), ventricular tachycardia (2.05, 1.27-3.31), peripheral arterial disease (1.99, 1.49-2.65), heart failure hospitalisation (1.78, 1.28-2.47), chronic kidney disease (1.65, 1.25-2.16), all-cause mortality (1.55, 1.42-1.70), cardiovascular mortality (1.55, 1.33-1.82), myocardial infarction (1.47, 1.28-1.68), ischaemic stroke (1.38, 1.18-1.62), and atrial fibrillation (1.38, 1.19-1.61) when compared to those without COPD. Despite substantial heterogeneity for all outcomes, associations between COPD and outcomes were broadly consistent across sensitivity analyses. Interpretation:COPD is associated with an increased risk for a range of incident cardiovascular diseases, chronic kidney disease and mortality. The impact of current and novel treatments on a broader range of cardiovascular and kidney outcomes in patients with COPD requires prospective randomised assessment. Funding:The British Heart Foundation.

BACKGROUND:The paucity of data to guide selection of specific vasoactive agents in patients with cardiogenic shock (CS) may lead to variability in practice patterns. The level of variability and specific factors that are associated with the use of vasoactive medications and inodilators have not been previously described. METHODS:The CCCTN (Critical Care Cardiology Trials Network) is an international, multicenter network of cardiac intensive care units (CICUs) coordinated by the TIMI Study Group. This analysis included CICU admissions for CS from 2019 to 2023. Variation in the use of inodilator treatment (dobutamine/milrinone) was assessed with multivariable mixed-effects logistic modeling. RESULTS:A total of 3282 admissions from 37 CICUs comprised the analysis cohort. The use of vasoactive medications, including inodilator treatment, varied substantially across institutions. Patient-level variables associated with greater use of inodilators included history of heart failure (odds ratio, 1.98 [95% CI, 1.61-2.44]), biventricular failure (1.59 [95% CI, 1.27-2.00]), Society of Cardiovascular Angiography and Interventions stage D (1.34 [95% CI, 1.07-1.68]), valvular disease (1.34 [95% CI, 1.03-1.74]), and male sex (1.23 [95% CI, 1.02-1.49]). Variables associated with less inodilator use included cardiac arrest (0.33 [95% CI, 0.27-0.42]), right ventricular failure (0.50 [95% CI, 0.33-0.73]), Society of Cardiovascular Angiography and Interventions stage E (0.57 [95% CI, 0.41-0.81]), acute myocardial infarction-CS (0.71 [95% CI, 0.56-0.90]), peripheral arterial disease (0.73 [95% CI, 0.54-0.99]), older age (0.77 [95% CI, 0.72-0.83], per 10-year increase), and estimated glomerular filtration rate (0.96 [95% CI, 0.93-0.99], per 10 mL/min per 1.73 m2 increase). No individual measurable institution-level factors (eg, transplant center) were associated with variability in inodilator use. In mixed-effects logistic modeling, 45.7% of variation in inodilator use was attributed to patient-level factors and 22.7% to the random effect of individual CICU centers. Similarly, 35.3% of variation in the use of dobutamine versus milrinone was attributed to patient-level factors and 32.6% to the random effect of individual CICU centers. CONCLUSIONS:There is significant variation in vasoactive treatment and inodilator use in CS. Variation in inodilator use was associated with patient-level factors and with substantial individual CICU practice variation. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.

Background Oral anticoagulation (OAC) reduces stroke in patients with atrial fibrillation (AF), but increases bleeding. Objectives This study aimed to evaluate an updated version of the Age, Biomarkers, and Clinical history of bleeding in AF (ABC-AF)-bleeding score (2.0) including consideration of OAC type (direct oral anticoagulant [DOAC] or warfarin) and compare its performance with other bleeding risk scores in 25 962 patients from the COMBINE AF cohort. Methods The COMBINE AF biomarker cohort contains individual participant data from patients with AF enrolled in 3 pivotal randomized trials comparing DOACs with warfarin. The biomarkers in the ABC-AF-bleeding score (growth differentiation factor 15, hemoglobin, and troponin-T) were analyzed in baseline samples. The biomarker-based ABC-AF-bleeding score was updated (version 2.0) by incorporating OAC type into the model (DOAC or warfarin). Discrimination was assessed by Harrell C-index and compared with clinically based bleeding scores; HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol), DOAC, and ORBIT (Older age, Reduced haemoglobin/haematocrit or history of anaemia, Bleeding history, Insufficient renal function, Treatment with antiplatelet agents). Results During follow-up, 1321 patients (5.1%) had an International Society on Thrombosis and Haemostasis major bleeding event, including 480 gastrointestinal, and 248 intracranial hemorrhages. The ABC-AF-bleeding 2.0 risk score showed better discrimination and calibration than the original version and provided superior discrimination than clinical risk scores for all outcomes. The ABC-AF-bleeding score 2.0 C-indices for major bleeding were 0.69 (95% CI, 0.68-0.71); gastrointestinal bleeding, 0.72 (95% CI, 0.69-0.74); and intracranial bleeding, 0.66 (95% CI, 0.63-0.70). The ABC-AF-bleeding score 2.0 also provided consistent superior discrimination in clinically relevant subgroups. Conclusion The updated ABC-AF-bleeding score 2.0 provided better discrimination and calibration for the risk of major bleeding than clinical risk scores, which was consistent across multiple subgroups. These findings support the utility of the ABC-AF-bleeding score for advancing precision medicine in AF.

Despite major advances in medical therapies and prevention strategies, the risk of cardiovascular complications in patients with both type I and type II diabetes remains substantially elevated. In 2019, the American Heart Association sought applications for a Strategically Focused Research Network on Cardiometabolic Health and Type 2 Diabetes. In 2020, 4 centers were named, including Brigham and Women’s Hospital, Johns Hopkins University, New York University, and the University of Iowa. These centers performed basic, translational, and clinical studies to provide insights to explain the over 2-fold risk of cardiovascular complications in diabetes. Clinical studies and studies in cells and animals aimed to uncover new mechanisms responsible for disease development. Studies using human populations sought to uncover new biomarkers to prognosticate risk. In this review, we discuss several key issues and current and developing methods to understand why diabetes drives atherosclerotic cardiovascular disease and heart failure. Both human data and experimental models are considered. We integrate a review of these topics with work from the Strategically Focused Research Network and conclude with suggestions for identifying novel risk factors and future experimental research.

AIMS:While the aging cardiac intensive care unit (CICU) population has been well studied, young adults represent a distinct and underexplored subgroup. We aimed to characterize the demographics, clinical presentations, resource utilization, and outcomes of young adults admitted to contemporary CICUs. METHODS AND RESULTS:We analysed consecutive adult CICU admissions from 2018 to 2023 within the Critical Care Cardiology Trials Network, a multicentre registry of advanced CICUs in North America. Patients aged 18-39 years were classified as 'young adults' and compared with those aged ≥40 years. Among 29 035 CICU admissions, 6.7% (n = 1959) were aged 18-39 years. Young adults were more likely to be female (40.0% vs. 36.4%, P = 0.001) and non-White (55.3% vs. 43.0%, P < 0.001), with fewer traditional cardiovascular risk factors. Heart failure was the leading admission diagnosis among young adults (26.4% vs. 19.5%, P < 0.001). Compared with older adults, young patients were more likely to present with cardiogenic shock (22.4% vs. 18.7%, P < 0.001) and cardiac arrest (12.7% vs. 10.6%, P = 0.003). Utilization of critical care therapies was higher, including mechanical circulatory support (13.1% vs. 11.4%, P = 0.02), with extracorporeal membrane oxygenation comprising a greater share (29.3% vs. 9.9%, P < 0.001). Young admissions had longer CICU stays [2.7 (1.2-5.8) vs. 2.2 (1.1-4.6) days, P < 0.001]. CICU mortality (6.5% vs. 10.5%, P < 0.001) and hospital mortality (9.5% vs. 14.4%, P < 0.001) were significantly lower in the young. CONCLUSION:Young adults admitted to the CICU represent a clinically distinct population, with higher rates of high-acuity presentations and intensive resource use yet lower short-term mortality.

IMPORTANCE:Since the cardiac intensive care unit was first introduced into the medical landscape, patient complexity, comorbidity, and illness severity have increased substantially over time. This evolution has required and informed the cultivation of new tools and an expanding skill set for those who deliver care in these units, and has paved the way for the emergence and growth of a distinct discipline-Critical Care Cardiology. With the genesis of this field and the need to care for comorbid and critically ill patients, numerous questions have been posed, including those related to optimal staffing models, appropriate training pathways, and the development of best practice principles to guide patient management. To address these and other challenges, to foster necessary collaborations, and to galvanize a maturing field, the Society of Critical Care Cardiology (SoCCC) was born. OBSERVATIONS:SoCCC was created to provide an independent, yet complementary home for stakeholders within this rapidly growing discipline. Its mission is to address the unique needs and concerns of Critical Care Cardiology through an inclusive approach that prioritizes the development of early career faculty, actively engaging them to help to shape the field and to strengthen its unique practice environment-the cardiac intensive care unit. While collaborations with larger professional societies remain essential, an independent subspecialty society like SoCCC intends to capitalize on the historical precedent and experiences shared by other successful organizations, while leveraging its nimble structure to advocate for and advance the needs of its constituency. CONCLUSIONS/RELEVANCE:While this document primarily details the history and rationale that led to the establishment of SoCCC, it also endeavors to be a practical blueprint to support future leaders who might be considering a new society for their own subspecialty.

BACKGROUND:Safe and effective decongestion remains an important therapeutic goal in patients hospitalized for heart failure. OBJECTIVES:The authors evaluated the effect of dapagliflozin on multiple clinically relevant measures of congestion among patients hospitalized for heart failure. METHODS:This was a prespecified analysis of DAPA ACT HF-TIMI 68 (Dapagliflozin Effect on Cardiovascular Events in Acute Heart Failure-Thrombolysis in Myocardial Infarction 68), a randomized, placebo-controlled trial evaluating in-hospital initiation of dapagliflozin on clinical outcomes through 2 months. The authors assessed placebo-adjusted changes from baseline in modified EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure) Composite Congestion Score (CCS), body weight, mean daily loop diuretic dose (furosemide 40 mg intravenous [IV] equivalents), and body weight adjusted for mean daily loop diuretic dose (diuretic efficiency) at 1 week, 1 month, and 2 months using linear mixed-effects models for repeated measures. RESULTS:At randomization, 12%, 63%, and 24% had no congestion (CCS 0), mild-to-moderate congestion (CCS 1-3), and severe congestion (CCS 4-9), respectively. Compared with placebo, dapagliflozin improved all decongestion-related endpoints by 1 week, including CCS (least squares mean difference [LSMD]: -0.18; 95% CI: -0.33 to -0.04; P = 0.011), body weight (LSMD: -0.60 kg; 95% CI: -0.95 to -0.26; P < 0.001), mean daily loop diuretic dose (LSMD: -0.12 furosemide 40-mg IV equivalents; 95% CI: -0.22 to -0.02; P = 0.014), and diuretic efficiency (LSMD: -0.93 kg/furosemide 40 mg IV equivalents; 95% CI: -1.61 to -0.25; P = 0.008). These improvements were sustained through 2 months, with progressive increases in diuretic efficiency through 2 months (LSMD: -1.99 kg/furosemide 40 mg IV equivalents; 95% CI: -3.19 to -0.78; P < 0.001). CONCLUSIONS:In-hospital initiation of dapagliflozin led to modest but significant improvements across multiple measures of congestion within 1 week that were sustained through 2 months. Diuretic efficiency progressively improved through 2 months. (Dapagliflozin Effect on Cardiovascular Events in Acute Heart Failure-Thrombolysis in Myocardial Infarction 68 [DAPA ACT HF-TIMI 68]; NCT04363697).

BACKGROUND:Pressure-adjusted heart rate (HR) (PAHR) provides an integrated assessment of hemodynamic decompensation in critical illness. OBJECTIVES:We aimed to evaluate the association of noninvasively obtained PAHR and mortality in cardiac intensive care unit (CICU) patients. METHODS:This was a retrospective cohort of patients with a transthoracic echocardiogram (TTE) within 24 hours of admission to an academic CICU (2007-2018). HR, right atrial pressure (RAP), and mean arterial pressure (MAP) obtained from the TTE were used to calculate PAHR as RAP · HR/MAP (in beats/min). The primary outcome was in-hospital mortality and secondary outcome was one-year mortality. RESULTS:Among 5,411 patients (median 70.1 years, 38.6% female, 92.4% White), higher PAHR was associated with greater acute illness severity, comorbidities, and critical care therapy utilization. The median PAHR was higher among patients who died while hospitalized (14.3 beats/min vs 6.8 BPM; P < 0.001). Echocardiographic measurements of biventricular function, filling pressures, and cardiac output were worse among those with higher PAHR. In-hospital mortality (adjusted OR: 1.03; 95% CI: 1.01 to 1.05; P = 0.001) and one-year (adjusted HR: 1.03; 95% CI: 1.02-1.04; P < 0.001) mortality increased with each 1 BPM higher PAHR. PAHR had moderate discrimination for in-hospital mortality (C-statistic 0.75). CONCLUSIONS:PAHR is a readily determinable composite measure of cardiovascular status that enhances clinical risk stratification of critically ill patients, performing better than MAP, HR, and Modified Shock Index. Among CICU patients, higher PAHR by TTE was associated with greater mortality.

BACKGROUND:Vasoactives are the predominant first line of therapy for management of cardiogenic shock (CS). Contemporary practice patterns regarding vasoactive agent selection in CS have not been well characterized. METHODS:The American Heart Association (AHA) CS Registry captures consecutive CS admissions across participating hospitals in the United States. Admissions treated with vasoactive agents within 6 hours of CS onset were included. Agents were categorized as inopressors (norepinephrine, epinephrine, dopamine), inodilators (dobutamine, milrinone), and pure vasopressors (vasopressin, phenylephrine). RESULTS:From 2022 to 2024, among 6847 CS admissions across 84 sites, 3387 (49.5%) were treated with a single vasoactive agent and 3460 (50.5%) were treated with ≥2 agents. Inopressors were used most commonly (73.7% of CS cases), with inodilators and pure vasopressors used in 48.3% and 27.5% of cases respectively. Norepinephrine was used most frequently (64.7%), followed by dobutamine (31.6%) and epinephrine (28.9%). Pure vasopressor use consisted primarily of vasopressin (83.5% of use). Use patterns differed by CS etiology with greater inopressor use in acute myocardial infarction-CS and greater inodilator use in acute-on-chronic heart failure-CS. Use of inopressors and pure vasopressors was greater and inodilator use lower in those with cardiac arrest, supported by mechanical circulatory support, or at higher Society of Cardiovascular Angiography and Interventions shock stage. CONCLUSIONS:In a broad population with CS in contemporary practice, inopressors are the most commonly used vasoactive category, with norepinephrine being the most frequently used agent. Several factors including CS etiology and severity are associated with differential practice patterns for vasoactive selection. These data depict the contemporary landscape and may help inform future evidence generation around optimal vasoactive selection for patients with CS.

BACKGROUND:Cardiogenic shock (CS) can be complicated by severe valvular heart disease (VHD). We analyzed cardiac intensive care unit (CICU) admissions according to VHD status. METHODS AND RESULTS:The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs. Centers contributed data from consecutive admissions during 2-month annual snapshots from 2017-2023. CS admissions were classified as having CS attributed to VHD, CS with noncausative VHD or CS without severe VHD. Demographics and therapies were compared. Unadjusted and adjusted odds ratios for in-hospital mortality were calculated. We analyzed 5242 admissions with CS (4.1% attributed to VHD, 18.8% with noncausative VHD, 77.1% without severe VHD). Mitral regurgitation (32.1%) and aortic stenosis (27.9%) were the most common pathologies in CS attributed to VHD. Admissions with CS attributed to VHD more commonly had LVEF ≥ 40% on admission (present in 62.8%, 22.6% and 15.1%, respectively; P < 0.001). Valve intervention was performed in 32.1% of those with CS attributed to VHD. Unadjusted in-hospital mortality in admissions with CS attributed to VHD was 40.0%, compared to 33.4% and 30.3% in the other groups. CONCLUSIONS:VHD is the underlying cause of CS in a minority of CICU admissions but is associated with high in-hospital mortality rates.

BACKGROUND:Cardiogenic shock (CS) develops in up to 10% of patients with ST-segment-elevation myocardial infarction and is associated with high mortality and morbidity rates. The objective of the current study was to generate a clinical scoring system that can be easily applied in the prehospital setting to predict the development of in-hospital CS among patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction. METHODS:The authors conducted a retrospective cohort study using prospective data from a dual hub-and-spoke health system. Logistic regression was used to assess the relationship between prespecified clinical predictors and the occurrence of in-hospital CS. Internal validation was conducted to assess the C statistic and calibration curve of the prediction model. The prediction model was converted to a risk score by scaling of the regression coefficients. RESULTS:From April 1, 2012, to December 31, 2020, there were 2736 consecutive patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Of these, 415 (15.2%) developed CS. Eight strong predictors were independently associated with CS by multivariable analysis and used to develop a prediction model. The model achieved a C statistic of 0.87. The EARLY SHOCK risk scoring algorithm incorporates Emergency Medical Services Heart Rate and Systolic Blood Pressure, Age, Renal Replacement, Location of Infarction, Sugar (diabetes), Heart Failure, and Cardiac Arrest. CONCLUSIONS:The authors identified 8 clinical variables that strongly predict CS among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. This has been developed into the EARLY SHOCK score, which can be easily applied in the prehospital setting to rapidly identify CS and enable shock team activation. External validation for the scoring system is pending for broader application.

BACKGROUND:Inflammation may play an important pathophysiological role in the development and progression of heart failure (HF). Interleukin (IL)-6 is a circulating cytokine and is the main regulator of the release of C-reactive protein (CRP). OBJECTIVES:The authors examined the association between IL-6 and high-sensitivity (hs)-CRP and outcomes in patients with HFrEF in the DAPA-HF trial and their relationship with the effect of dapagliflozin. METHODS:Inclusion criteria included: 1) NYHA functional class II-IV; 2) left ventricular ejection fraction ≤40%; 3) elevated N-terminal pro-B-type natriuretic peptide; and 4) estimated glomerular filtration rate ≥30 mL/min/1.73 m2. The primary outcome was a composite of a worsening HF event or cardiovascular death. IL-6 and hs-CRP were measured at baseline and 12 months (Roche Diagnostics). The associations between IL-6 and hs-CRP and outcomes were adjusted for known prognostic variables, including NT-proBNP. RESULTS:Among 2,940 patients, median IL-6 and hs-CRP at baseline were 6.01 pg/mL (Q1-Q3: 4.18-9.28 pg/mL) and 2.05 mg/L (Q1-Q3: 0.83-4.9 mg/L), respectively. Baseline IL-6 tertiles (T) were: T1 ≤4.72 pg/mL; T2 4.73-7.89 pg/mL; and T3 ≥7.90 pg/mL. The adjusted risks of the primary outcome relative to T1 were as follows: T2 = HR 1.34 (95% CI: 1.04-1.73) and T3 = HR 1.80 (95% CI: 1.41-2.31). A rise in IL-6 between baseline and 12 months was associated with worse outcomes. The beneficial effect of dapagliflozin on the primary outcome was consistent regardless of IL-6 concentration (continuous interaction P = 0.57), with similar results for hs-CRP. Dapagliflozin did not reduce IL-6 or hs-CRP at 12 months. CONCLUSIONS:In DAPA-HF, elevated IL-6 and hs-CRP levels were each associated with the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of adverse outcomes regardless of baseline IL-6 or hs-CRP. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).

BACKGROUND:Among patients with cardiogenic shock (CS), higher right atrial pressure (RAP) and lower mean arterial pressure (MAP) are associated with higher in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate × RAP/MAP, integrates these parameters. The prognostic significance of PAHR has not been assessed in patients with CS. OBJECTIVES:The authors aimed to assess if PAHR values are associated with risk of in-hospital mortality in patients with CS. METHODS:CCCTN (Critical Care Cardiology Trials Network) is a multinational registry of cardiac intensive care units coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24 hours of cardiac intensive care unit admission, we assessed the relationship of PAHR with in-hospital mortality. Patients with concurrent mechanical circulatory support were excluded in the primary analysis. ORs were adjusted for age, sex, vasoactive-inotropic score, Society for Cardiovascular Angiography and Interventions (SCAI) stage, and preceding cardiac arrest. RESULTS:Among the 1411 CS admissions in the analysis (18% with acute myocardial infarction), 75% were receiving vasoactive support at the time of assessment. Median heart rate was 92 beats/min, RAP 15 mm Hg, MAP 75 mm Hg, and PAHR 17. There was a stepwise gradient of higher in-hospital mortality with higher presenting PAHR values. In adjusted models, a higher PAHR was incrementally associated with higher in-hospital mortality (adjusted OR per 10 units: 1.35 [95% CI: 1.15-1.58]), and PAHR had stronger prognostic associations with mortality than its individual hemodynamic components. CONCLUSIONS:PAHR, a simple hemodynamic index calculated from vital signs and central venous pressure, is strongly associated with in-hospital mortality in CS.

BACKGROUND:Heart failure-related cardiogenic shock (HF-CS) accounts for a growing proportion of cardiogenic shock (CS)-related admissions to contemporary cardiac intensive care units. Limited data exist comparing nonischemic (NICM) and ischemic cardiomyopathy (ICM) in this setting. METHODS AND RESULTS:We sought to examine the differences in patients' characteristics, in-hospital treatments and outcomes in individuals admitted with ICM and NICM HF-CS. The study population included CS admissions within the Critical Care Cardiology Trials Network registry from 2017-2022. CS due to acute myocardial infarction or secondary causes was excluded. Admission characteristics, in-hospital treatments and outcomes were captured. The primary outcome of all-cause in-hospital mortality for ICM vs NICM was compared by using multivariable logistic regression; 2463 hospital admissions for HF-CS, including 902 (36.6%) admissions with ICM and 1561 (63.4%) admissions with NICM, were included. Patients with ICM more commonly had pre-existing comorbidities, pre-admission cardiac arrest and higher Sequential Organ Failure Assessment scores. The use of inotropes and temporary mechanical circulatory support was similar; however, the rates of mechanical ventilation and renal-replacement therapies were higher for ICM. Patients with ICM were less likely to undergo cardiac transplantation but had similar rates of durable left ventricular assist device implantation. After multivariable adjustment, patients with ICM were significantly more likely to die during the index hospitalization (OR 1.56, 95% CI 1.26-1.93; P < 0.001). CONCLUSIONS:Among patients admitted to cardiac intensive care units with HF-CS, patients with ICM were sicker, less likely to undergo cardiac transplantation, and more likely to die when compared with patients with NICM.

BACKGROUND:The epidemiology and prognostic significance of acute noncardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined. METHODS:CS admissions from 2017 to 2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurological dysfunction using established criteria. Burden of organ dysfunction was defined as no noncardiac organ dysfunction (NOD), single organ dysfunction, or multiorgan dysfunction (≥2) (MOD). Multivariable models were used to evaluate associations of burden and type of noncardiac organ dysfunction with in-hospital death. RESULTS:Among 3904 CS admissions, 29.4% had AMI-CS, 50.9% had AoC HF-CS, and 19.7% had de novo HF-CS. AMI-CS and de novo HF-CS had greater prevalence of MOD (35.0% and 33.9%, respectively) compared with AoC HF-CS (23.1%; P < .01). In-hospital mortality was higher with a greater burden of organ dysfunction in the overall CS cohort (single organ dysfunction vs NOD, adjusted odds ratio [aOR] for in-hospital death 2.5, 95% confidence interval [CI] 2.0-3.2; MOD vs NOD: aOR 6.5, 95% CI 5.1-8.2) and across each CS subtype. Kidney dysfunction was the most prognostically important form of organ dysfunction in the overall cohort (aOR 4.1, 95% CI 3.4-5.0) and for each CS subtype. CONCLUSIONS:Admissions for AoC HF-CS had a lower burden of acute noncardiac organ dysfunction compared with admissions for de novo HF-CS and AMI-CS. However, acute noncardiac organ dysfunction burden was similarly adversely prognostic across all CS subtypes.