Acute cardiac care & resuscitationResearch article
Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN)
- analysis of an international, multicenter network of cardiac intensive care units
- multivariable mixed-effects logistic modeling
Authors' conclusion
There is significant variation in vasoactive treatment and inodilator use in CS. Variation in inodilator use was associated with patient-level factors and with substantial individual CICU practice variation. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.
Study context
- Population
- CICU admissions for cardiogenic shock (CS), 2019 to 2023, CCCTNadmissions from 37 cardiac intensive care units (CICUs)
- Participants
- 3,282 admissions
- Comparison
- Variation in the use of inodilator treatment
Main finding
As reported in the abstract
- varied substantially across institutions
Further findings
Patient-level variables associated with greater use of inodilators
| Comparison | odds ratio (95% CI) | |
|---|---|---|
| history of heart failure · greater inodilator use | 1.98 (1.61–2.44) | |
| biventricular failure · greater inodilator use | 1.59 (1.27–2.00) | |
| Society of Cardiovascular Angiography and Interventions stage D · greater inodilator use | 1.34 (1.07–1.68) | |
| valvular disease · greater inodilator use | 1.34 (1.03–1.74) | |
| male sex · greater inodilator use | 1.23 (1.02–1.49) | |
| 0.512Odds ratio (log scale) |
Variables associated with less inodilator use
| Comparison | odds ratio (95% CI) | |
|---|---|---|
| cardiac arrest · less inodilator use | 0.33 (0.27–0.42) | |
| right ventricular failure · less inodilator use | 0.50 (0.33–0.73) | |
| Society of Cardiovascular Angiography and Interventions stage E · less inodilator use | 0.57 (0.41–0.81) | |
| acute myocardial infarction-CS · less inodilator use | 0.71 (0.56–0.90) | |
| peripheral arterial disease · less inodilator use | 0.73 (0.54–0.99) | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Estimate | |
|---|---|---|
| Variables associated with less inodilator use — older age · less inodilator use | odds ratio 0.77 per 10-year increase (95% CI 0.72–0.83) | |
| Variables associated with less inodilator use — estimated glomerular filtration rate · less inodilator use | odds ratio 0.96 per 10 mL/min per 1.73 m 2 increase (95% CI 0.93–0.99) | |
| 0.512Odds ratio (log scale) |
Institution-level factors and inodilator use
- No individual measurable institution-level factors (eg, transplant center) were associated with variability in inodilator use
Variation in inodilator use explained
- attributed to patient-level factors
- 45.7%
- attributed to the random effect of individual CICU centers
- 22.7%
- mixed-effects logistic modeling
Variation in the use of dobutamine versus milrinone explained
- attributed to patient-level factors
- 35.3%
- attributed to the random effect of individual CICU centers
- 32.6%
Original publication
Summarised from the published abstract; every number is checked against it