Whether patients with cardiogenic shock survive also depends on which hospital they are treated in. This is shown by a new study by the University Heart and Vascular Centre Hamburg at the University Medical Centre Hamburg-Eppendorf (UKE) and partners in the European Journal of Heart Failure.
Cardiogenic shock is the most severe form of acute heart failure, usually occurring after a heart attack. In the United Kingdom, around 44,000 people are affected each year, with more than half dying in hospital. To maintain blood circulation, mechanical circulatory support systems (MCS) such as ECMO or the Impella pump are increasingly being used. These are complex to operate and require experienced teams.
Big differences between hospitals
The study analysed data from more than 220,000 patients treated for cardiogenic shock in Germany between 2017 and 2021. The result:
- In hospitals with high case numbers, the risk of death fell significantly.
- Those treated in a clinic that treats more than 90 cases of cardiogenic shock per year had a better chance of survival.
- MCS therapies showed an even stronger effect: in centres with more than 25 MCS procedures per year, the risk of death was around 20 per cent lower.
Centralisation could save lives
‘Our data clearly shows that experience saves lives,’ says study leader PD Dr Benedikt Schrage, Clinic and Polyclinic for Cardiology at the UKE and the German Centre for Cardiovascular Research (DZHK). ‘If patients with cardiogenic shock were systematically transferred to specialised centres, many deaths could be avoided.’
The researchers therefore propose centralising care more closely, following the example of stroke or heart attack networks. This would enable patients to be transferred more quickly to hospitals that have the necessary expertise and resources for this high-risk situation.
Background: cardiogenic shock
Cardiogenic shock is the most severe form of acute heart failure. The heart is no longer able to supply the body with sufficient blood and oxygen. This usually occurs after a severe heart attack, but can also be caused by myocarditis, pulmonary embolism or surgery. Typical signs include a sharp drop in blood pressure, shortness of breath, cold skin or confusion. Without rapid treatment – with medication, emergency measures or circulatory support – vital organs can fail, often with fatal consequences.
Original publication:
Higher hospital volume is associated with lower mortality for patients with cardiogenic shock and mechanical circulatory support. Dettling et al., Eur J Heart Fail, 2025 Aug 31, https://onlinelibrary.wiley.com/doi/10.1002/ejhf.70025
