The Association of Off-Hour vs. On-Hour ICU Admission Time with Mortality in Patients with Cardiogenic Shock - a Retrospective Multicenter Analysis

Background: Studies have shown a so-called off-hour effect for many different diseases, but data are scarce concerning cardiogenic shock. We therefore assessed the association of off-hour vs. on-hour intensive care unit (ICU) admission with 30-day mortality in patients with cardiogenic shock.

Methods: In total, 1720 cardiogenic shock patients (666 admitted during off-hours) from two large university hospitals in Germany were included in retrospect.

Results: An admission during off-hours was associated with an increased 30-day mortality compared to an admission during on-hours (crude mortality 48% vs. 41%, HR 1.17 (1.03-1.33), p = 0.017). This effect remained significant after propensity score matching (p = 0.023). Neither patients with a combined SCAI stage D and E (p = 0.088) or C (p = 0.548) nor those requiring cardiopulmonary resuscitation (p = 0.114) had a higher mortality at off-hour admission. In contrast, those without veno-arterial extracorporeal membrane oxygenation (VA-ECMO) (HR 1.17 (1.00-1.36), p = 0.049), without acute myocardial infarction (HR 1.27 (1.02-1.56), p = 0.029) or a with combined SCAI stage A and B (HR 2.23 (1.08-4.57), p = 0.025) had an increased mortality at off-hour admission.

Conclusion: Our study showed an increased mortality in patients with cardiogenic shock admitted during off-hours especially in those with a milder onset of disease. This stresses the importance of a thorough workup of each patient especially at times of limited resources, the menace of underestimating the severity of cardiogenic shock and the need for an improved twenty-four seven available risk stratification.