National Evaluation of Epidemiology, Management and Outcomes in Cardiogenic Shock

Background Cardiogenic shock is a syndrome whereby low cardiac output causes hypoperfusion and multi-organ failure. Mortality ranges from 30-50%.

Despite its lethality, there are no NHS-specific data to guide clinical practice, inform patient pathways and drive innovation.

There is a risk that outcomes in the UK are worse than those in other healthcare systems; pilot data from Scotland suggest an in-hospital mortality of 55%.

I hypothesise that there is substantial variation in the management of CS, and that some of this variation represents modifiable risk factors causally associated with mortality.

NHS specific data are urgently needed to ensure that patients receive and have equitable access to best care across the UK.

Aims My aim is to comprehensively study and describe the epidemiology, clinical care and outcomes of patients admitted to critical care units in the UK with cardiogenic shock.

My objectives are: To conduct a retrospective cohort study of patients diagnosed with cardiogenic shock within the ICNARC CMP To conduct a prospective observational cohort study of patients with cardiogenic shock To validate and calibrate existing ICNARC risk prediction models for patients admitted to critical care with cardiogenic shock To compare demographics, care patterns and patient outcomes between the UK and North America Methods Using skills and knowledge gained from my bespoke training in statistics and epidemiology, I will analyse data collected within the Intensive Care National Audit and Research Consortium Case Mix Program (ICNARC-CMP).

Utilising an algorithm that has been developed and validated using routine ICNARC-CMP data to identify patients with cardiogenic shock, I will conduct a 13-year retrospective and two-year prospective observational cohort study of patients admitted to critical care.

The prospective study will also include data from a cardiogenic shock module (14 additional data elements) which has been embedded into the existing ICNARC-CMP dataset to provide detailed information on the aetiology, management and outcomes of cardiogenic shock.

The primary analyses will be descriptive including incidence and epidemiological trends in incidence, mortality and length of stay. Survival analysis methods will be used for outcomes.

Comparative analyses will be conducted with a North American cohort from the Cardiac Critical Care Trials Network to identify any differences in management and patient outcomes. Timelines Months 1-12: Retrospective cohort study and formal training in statistics and epidemiology.

Months 12-30: Prospective cohort study, validation of predictive models and comparative analysis and prospective cohort study. Months 30-36: Finalise and submit PhD thesis, write associated manuscripts.

Impact & Dissemination Results will be published in high-impact scientific journals and presented at international meetings and to patient and public forums.

I anticipate these data will benefit: patients by providing essential data to support optimal design of care pathways and best practices and the identification of potential treatments for future interventional studies; the NHS by providing key information on the resources used by a group of patients with high healthcare costs and mortality; and researchers by creating a robust infrastructure for the future conduct of registry-based trials in cardiogenic shock.