AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute-on-chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients with de novo and acute-on-chronic HF-CS. METHODS AND RESULTS: In this international observational study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation and 30-day mortality, adjusted logistic/Cox regression models were fitted. Patients (n = 1030) with HF-CS were analysed, of whom 486 (47.2%) presented with de novo HF-CS and 544 (52.8%) with acute-on-chronic HF-CS. Traditional markers of CS severity (e.g. blood pressure, heart rate and lactate) as well as use of treatments were comparable between groups. However, patients with acute-on-chronic HF-CS were more likely to have a higher CS severity and also a higher mortality risk, after adjusting for relevant confounders (de novo HF 45.5%, acute-on-chronic HF 55.9%, adjusted hazard ratio 1.38, 95% confidence interval 1.10-1.72, p = 0.005). CONCLUSION: In this large HF-CS cohort, acute-on-chronic HF-CS was associated with more severe CS and higher mortality risk compared to de novo HF-CS, although traditional markers of CS severity and use of treatments were comparable. These findings highlight the vast heterogeneity of patients with HF-CS, emphasize that HF chronicity is a relevant disease modifier in CS, and indicate that future clinical trials should account for this.

Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy

Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Italy

Center for Population Health Innovation University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Cardiology and Angiology University Heart Center Freiburg Bad Krozingen Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology AZ Sint Lucas Ghent Belgium

Department of Cardiology Charité Universitätsmedizin Berlin Campus Benjamin Franklin Berlin Germany

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany

Department of Cardiology University Heart and Vascular Center Hamburg Hamburg Germany

Department of Cardiothoracic and Vascular Anesthesia and Intensive Care SS Antonio e Biagio e Cesare Arrigo Hospital Alessandria Italy

Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Italy

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Science Leipzig Germany

Department of Medicine 1 University Hospital LMU Munich Munich Germany

Department of Perioperative Medicine St Bartholomew's Hospital London

Division of Cardiology Pulmonology and Vascular Medicine Medical Faculty University Duesseldorf Duesseldorf Germany

German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany

Intensive Cardiac Care Unit and De Gasperis Cardio Center Niguarda Hospital Milan Italy

IRCCS S Maria Nascente Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

Rigshospitalet and Department of Clinical Medicine University of Copenhagen Copenhagen Copenhagen Denmark

Technische Universität Dresden Heart Centre Dresden University Hospital Department for Internal Medicine and Cardiology Dresden Germany

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

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Hemodynamic management of cardiogenic shock in the intensive care unit

Sex-related differences in patients presenting with heart failure-related cardiogenic shock