Higher hospital cardiac capability is independently associated with lower mortality among patients with cardiogenic shock, and advanced centers are associated with mitigation of transfer-associated risk, supporting regionalized hub-and-spoke systems with early referral to high-capability centers.
Crude in-hospital mortality for cardiogenic shock declined stepwise from non-PCI hospitals to transplant/LVAD centers.
After multivariable adjustment, higher hospital tier was independently associated with lower in-hospital mortality compared to tier 1 (non-PCI) hospitals.
Transfer-in status was independently associated with increased in-hospital mortality among cardiogenic shock patients.
The transfer-associated mortality risk was attenuated at cardiac surgical and transplant/LVAD centers, suggesting mitigation of the transfer penalty at higher-capability hospitals.
Most cardiogenic shock hospitalizations in the study period occurred at cardiac surgical and transplant/LVAD centers.
A latent Acute Severity construct was incorporated into the modeling framework to account for the effects of clinical instability on mortality.
This research suggests that where a patient with cardiogenic shock (a life-threatening condition where the heart cannot pump enough blood) receives care matters enormously for survival. Analyzing over 1.1 million hospitalizations from 2016 to 2022, researchers found that patients treated at hospitals with the highest cardiac capabilities—such as those able to perform heart transplants or implant permanent heart pumps—had roughly half the mortality rate compared to patients at hospitals without heart procedure capabilities (about 36.5% versus 64.4%). Even after accounting for how sick patients were when they arrived, being treated at a higher-capability hospital was strongly and independently linked to better survival. The study also examined what happens when patients are transferred from one hospital to another, a common scenario in emergency cardiac care. Being transferred was associated with a 36% higher odds of dying, a phenomenon the researchers call the 'transfer penalty.' However, this penalty appeared to be reduced when patients were transferred to the highest-capability centers (cardiac surgical and transplant/LVAD hospitals), suggesting that the benefits of reaching an advanced center can offset some of the risks of the transfer process itself. This research suggests that organizing cardiac shock care into formal regional networks—where lower-capability hospitals quickly identify and transfer appropriate patients to high-capability 'hub' centers—could help save lives. The findings support early transfer to advanced centers rather than prolonged stabilization attempts at facilities with limited cardiac resources, though the study's observational design using a national hospital database means it cannot definitively prove that the hospitals themselves caused the improved outcomes.
Sethi A, Hiltner E, Awasthi A, Panebianco C, LaPlaca T, Rizzuto N, et al.. (2026). Association Between Hospital Tiers and Cardiogenic Shock Mortality: Mitigating the Transfer Penalty Through a Regionalized Hub-and-Spoke Model.. Circulation. Heart failure. https://doi.org/10.1161/CIRCHEARTFAILURE.126.014546