Acute cardiac care & resuscitationCohort study
Association Between Hospital Tier and Cardiogenic Shock Outcomes in the United States
- Retrospective cohort study
- Nationwide Readmissions Database (2016-2022)
- multinomial overlap propensity adjustment
- hierarchical regression models
Authors' conclusion
Tiered CS care was associated with a stepwise improvement in survival outcome at advanced centers despite greater acuity of illness.
Study context
- Population
- Adults (≥18 years) hospitalized with cardiogenic shock, US, 2016–2022
- Participants
- 623,835 cardiogenic shock (CS) admissions
- Exposure
- CS centre levels 1A, 2 and 3 vs level 1
- Outcome
- In-hospital mortality
Main finding
As reported in the abstract
Each group vs level 1Adjusted odds ratio (95% CI)P value
Level 1A
1.33(1.29–1.38)
P < 0.001Level 2
1.44(1.38–1.50)
P < 0.001Level 3
1.63(1.54–1.71)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Receipt of MCS — Level 1A vs Level 1 · 38% lower | aOR 0.62 (95% CI 0.59–0.65) | |
| Receipt of MCS — Level 2 vs Level 1 · 73% lower | aOR 0.27 (95% CI 0.25–0.28) | |
| 30-day readmissions (survivors) · 30 days — Level 1A vs Level 1 · lower by 4% | OR 0.96 (95% CI 0.94–0.98) | |
| 30-day readmissions (survivors) · 30 days — Level 2 vs Level 1 · no significant difference | OR 1.02 (95% CI 0.99–1.06) | |
| 0.20.5125Ratio (log scale) |
| Outcome | OR (95% CI) |
|---|---|
| 30-day readmissions (survivors) · 30 days — Level 3 vs Level 1 · lower by 1% | 0.99 (0.94–0.98) |
In-hospital mortality by subgroup (age, cardiac arrest, mechanical circulatory support (MCS) use, location, insurance)
- Survival benefit of level 1 centres persisted across subgroups
Length of stay and costs
- Higher at levels 1 and 1A
Original publication
Association Between Hospital Tier and Cardiogenic Shock Outcomes in the United States. JACC Heart Fail. Published 9 May 2026. doi:10.1016/j.jchf.2026.103100
Summarised from the published abstract; every number is checked against it