De Novo vs Acute-on-Chronic Presentations of Heart Failure-Related Cardiogenic Shock: Insights from the Critical Care Cardiology Trials Network Registry

Ankeet S. Bhatt, David D. Berg, Erin A. Bohula, Carlos L. Alviar, Vivian M. Baird-Zars, Christopher F. Barnett, James A. Burke, Anthony P. Carnicelli, Sunit Preet Chaudhry, Lori B. Daniels, James C. Fang, Christopher B. Fordyce, Daniel A. Gerber, Jianping Guo, Jacob C. Jentzer, Jason N. Katz, Norma Keller, Michael C. Kontos, Patrick R. Lawler, Venu MenonThomas S. Metkus, Jose Nativi-Nicolau, Nicholas Phreaner, Robert O. Roswell, Shashank S. Sinha, R. Jeffrey Snell, Michael A. Solomon, Sean Van Diepen, David A. Morrow

Research output: Contribution to journalArticlepeer-review


Background: Heart failure-related cardiogenic shock (HF-CS) accounts for an increasing proportion of cases of CS in contemporary cardiac intensive care units. Whether the chronicity of HF identifies distinct clinical profiles of HF-CS is unknown. Methods and Results: We evaluated admissions to cardiac intensive care units for HF-CS in 28 centers using data from the Critical Care Cardiology Trials Network registry (2017–2020). HF-CS was defined as CS due to ventricular failure in the absence of acute myocardial infarction and was classified as de novo vs acute-on-chronic based on the absence or presence of a prior diagnosis of HF, respectively. Clinical features, resource use, and outcomes were compared among groups. Of 1405 admissions with HF-CS, 370 had de novo HF-CS (26.3%), and 1035 had acute-on-chronic HF-CS (73.7%). Patients with de novo HF-CS had a lower prevalence of hypertension, diabetes, coronary artery disease, atrial fibrillation, and chronic kidney disease (all P < 0.01). Median Sequential Organ Failure Assessment (SOFA) scores were higher in those with de novo HF-CS (8; 25th–75th: 5–11) vs acute-on-chronic HF-CS (6; 25th–75th: 4–9, P < 0.01), as was the proportion of Society of Cardiovascular Angiography and Intervention (SCAI) shock stage E (46.1% vs 26.1%, P < 0.01). After adjustment for clinical covariates and preceding cardiac arrest, the risk of in-hospital mortality was higher in patients with de novo HF-CS than in those with acute-on-chronic HF-CS (adjusted hazard ratio 1.36, 95% confidence interval 1.05–1.75, P = 0.02). Conclusions: Despite having fewer comorbidities, patients with de novo HF-CS had more severe shock presentations and worse in-hospital outcomes. Whether HF disease chronicity is associated with time-dependent compensatory adaptations, unique pathobiological features and responses to treatment in patients presenting with HF-CS warrants further investigation.

Original languageEnglish (US)
Pages (from-to)1073-1081
Number of pages9
JournalJournal of cardiac failure
Issue number10
StatePublished - Oct 2021


  • cardiogenic shock
  • critical care cardiology
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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