Undiagnosed Early Cardiogenic Shock Linked to Increased Mortality

A recent study conducted across six hospitals in the United States has highlighted alarming outcomes for patients experiencing early-stage cardiogenic shock, with significant rates of transfer to higher levels of care, progression to severe shock, and mortality. The research, which analyzed 500 medical records from patients diagnosed between 2017 and 2022, revealed that more than 26% of these patients faced either serious deterioration or death due to delayed recognition and treatment of their condition.

Dr. Saraschandra Vallabhajosyula, a cardiologist at the Warren Alpert Medical School of Brown University, stated that early-stage cardiogenic shock is often mischaracterized as less critical compared to classic cardiogenic shock presentations. "These patients are thought to be typically not nearly as sick as those with classically manifested cardiogenic shock," he explained. The findings suggest that better identification of early-stage shock is crucial, as patients' conditions deteriorated within an average of just 16 hours.

The study found that only 24% of the cases of early-stage cardiogenic shock were correctly recognized, predominantly among those whose condition worsened. Dr. Shashank Sinha, a cardiologist at Inova Fairfax Medical Campus and author of current clinical guidelines on cardiogenic shock, emphasized the need for immediate recognition of early shock stages. He stated, "We are increasingly recognizing that it’s bad. There can be significant deterioration to a higher stage, with worsening mortality. This study serves as a call to action."

Among the patients studied, 49% were transferred to a higher level of care, 62% experienced worsening shock, and 41% died in the hospital. The research also highlighted low rates of critical interventions such as right heart catheterization, which was performed in only 8.6% of cases, and coronary angiography, conducted in 7% of cases. These interventions are vital in preventing the progression of shock, and Dr. Sinha noted, “That’s a potential opportunity.”

The study identified diuretic resistance over the previous 24 hours as the strongest predictor of poor outcomes, with acute kidney and liver injuries also contributing to negative prognoses. Researchers classified patients based on the Society of Cardiovascular Angiography and Interventions (SCAI) criteria, where hypotension alone is classified as stage B and hypoperfusion as stage C. Dr. Sinha indicated that both indicators are critical for early recognition and classification of cardiogenic shock, which is currently under revision.

Efforts to improve recognition of shock in clinical settings are essential, according to both Vallabhajosyula and Sinha. They suggested that enhanced surveillance of patients outside intensive care units is necessary, noting that shock can present in various hospital departments. Vallabhajosyula emphasized the need for education among all healthcare providers, stating, "Other specialties need to be well-versed and have a low index of suspicion for this [shock]." He criticized the current focus on blood pressure alone, arguing for more frequent testing of liver function and lactate levels to better identify shock.

The study underscores the potential of electronic medical records to implement clinical decision support tools that can alert healthcare providers to patients at risk of cardiogenic shock. Dr. Sinha highlighted the importance of learning from critical care colleagues who developed sepsis alerts, advocating for similar systems to be incorporated into electronic health records to enhance patient outcomes.

These findings were presented at the 2025 Scientific Sessions of the Society for Cardiovascular Angiography and Interventions, emphasizing the urgent need for changes in clinical management to address the challenges posed by undiagnosed early-stage cardiogenic shock. Both Vallabhajosyula and Sinha reported no relevant financial conflicts of interest in relation to this study.