Abstract 12839: A Standardized and Regionalized System of Care Network for Cardiogenic Shock: Insights From the Inova-Shock Registry

Introduction: Recent studies have demonstrated improved short-term outcomes with cardiogenic shock (CS) at centers using standardized protocols. Whether these benefits may be extended across systems of care networks is unknown. Objective: To investigate clinical characteristics & short-term outcomes of CS patients initially managed at spoke hospitals & transferred, & those admitted directly to the hub. Methods: Observational study of 520 consecutive CS patients (1/3/2017-12/31/2019) treated in a regionalized network of 34 spoke hospitals across 600 sq miles. Presenting location, clinical characteristics, mechanical circulatory support (MCS) use & outcomes were compared. Multivariate logistic regression was employed to determine factors associated with 30-day mortality. Results: Fifty five percent (n=287) initially presented to a spoke. They were more likely to have CS due to acute myocardial infarction (50.5% vs 31.8%; p < 0.01) & be supported initially with an IABP (32.1% 17.2%; p <0.01). They were also more likely to require escalation to Impella + VA-ECMO at the hub. Hub patients had higher index lactates (2.7 vs 2.3 mg/dL; p =0.04). No differences were seen between the hub and spoke cohorts in regard to 30-day mortality (39.1% vs 36.4; p=0.60), major bleeding (19% vs 23%; p=0.23), stroke (9.4% vs 7.0%; p=0.33), & 30-day readmissions (24% vs 21%; p=0.53) (Figure 1) Independent factors associated with 30-day mortality were age, diabetes, baseline lactate > 2.0 mg/dL & index SCAI shock stages D & E. Initial presentation to a spoke was not (aOR 0.81; 95% CI 0.49-0.38; p =0.38 ) Conclusions: Despite differences in CS etiology and initial MCS use, the hub and spoke cohorts had similar 30-day mortality & associated short-term outcomes. Creating a regionalized system of CS care across a multi-hospital network with dedicated protocols & expedited transfer algorithms may provide similar benefits for patients initially presenting to either hub or spoke shock care centers.