Acute cardiac care & resuscitation
Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN)
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
- Outcome
- Use of vasoactive medications, including inodilator treatment, across institutions
Methodological detailsmultivariable mixed-effects logistic modeling
- Multivariable mixed-effects logistic modeling
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 failureGreater inodilator use | 1.98 (1.61–2.44) | |
| Biventricular failureGreater inodilator use | 1.59 (1.27–2.00) | |
| Society of Cardiovascular Angiography and Interventions stage DGreater inodilator use | 1.34 (1.07–1.68) | |
| Valvular diseaseGreater inodilator use | 1.34 (1.03–1.74) | |
| Male sexGreater 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 arrestLess inodilator use | 0.33 (0.27–0.42) | |
| Right ventricular failureLess inodilator use | 0.50 (0.33–0.73) | |
| Society of Cardiovascular Angiography and Interventions stage ELess inodilator use | 0.57 (0.41–0.81) | |
| Acute myocardial infarction-CSLess inodilator use | 0.71 (0.56–0.90) | |
| Peripheral arterial diseaseLess inodilator use | 0.73 (0.54–0.99) | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Estimate | |
|---|---|---|
| Variables associated with less inodilator useOlder age · less inodilator use | odds ratio 0.77 per 10-year increase (95% CI 0.72–0.83) | |
| Variables associated with less inodilator useEstimated 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
Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN). Circ Heart Fail. Published 7 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it