Impact of comorbidity burden on outcome in patients with cardiogenic shock: A Cardiogenic Shock Working Group analysis.
Publication Title
European journal of heart failure : journal of the Working Group on Heart Failure of the European Society of Cardiology
Document Type
Article
Publication Date
9-16-2025
Keywords
Acute myocardial infarction‐related cardiogenic shock; Cardiogenic shock; Comorbidities; Comorbidity burden; Heart failure‐related cardiogenic shock; Multimorbidity; Risk stratification; oregon; cards; cards publication
Abstract
AIMS: Comorbidity burden is a major determinant of outcomes. Its prognostic impact on cardiogenic shock (CS) across CS subtypes remains insufficiently characterized. We aimed to characterize the prevalence and distribution of comorbidities in CS, assess their impacts on outcomes, and identify high-risk comorbidity patterns in all-cause, acute myocardial infarction-related (AMI-CS) and heart failure-related CS (HF-CS).
METHODS AND RESULTS: Cardiogenic shock patients from the multicentre Cardiogenic Shock Working Group (CSWG) registry (2020-2024) were analysed. We used adjusted logistic regression models to assess the impact of comorbidities individually, in combination, and as a cumulative burden on in-hospital mortality. We developed the Comorbidity Risk Index for Cardiogenic Shock (COMRI-CS) to capture the association between comorbidities and CS mortality. Among 6815 patients (26.5% AMI-CS, 53.6% HF-CS), 6087 (89.3%) presented with ≥1 comorbidity, and 4390 (64.4%) with ≥3 comorbidities. In-hospital mortality increased with comorbidity burden (AMI-CS: 35.4%, 39.6%, 47.1% with 1-3, 4-6, ≥7 comorbidities, respectively; HF-CS: 19.6%, 24.9%, 27.5%, respectively). A high comorbidity burden was independently associated with a 51% higher relative mortality risk in AMI-CS (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.02-2.23, p = 0.037), and a more pronounced increase of 122% in HF-CS (OR 2.22, 95% CI 1.49-3.37, p < 0.001). Distinct high-risk comorbidities and combinations were identified, varying across CS subtypes. With each COMRI-CS point, in-hospital mortality increased by ~5.5%.
CONCLUSIONS: In this large real-world CS cohort, comorbidity burden was highly prevalent, varied across subtypes, and was independently associated with mortality. Integrating chronic conditions into early CS risk stratification may enhance clinical decision-making in CS management.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
DOI
10.1002/ejhf.70017
