title: Decade-Long Trends (2001-2011) in the Incidence and Hospital Death Rates Associated with the In-Hospital Development of Cardiogenic Shock after Acute Myocardial Infarction.
abstract: BACKGROUND
  Limited information is available about relatively contemporary trends in the incidence and hospital case-fatality rates of cardiogenic shock in patients hospitalized with acute myocardial infarction. The purpose of this population-based study was to describe decade long trends (2001-2011) in the incidence and hospital case-fatality rates for patients who developed cardiogenic shock during hospitalization for an acute myocardial infarction.
  
  
  RESULTS
  The study population consisted of 5686 residents of central Massachusetts hospitalized with acute myocardial infarction at all 11 medical centers in the Worcester, MA, metropolitan area during 6 biennial periods between 2001 and 2011, who did not have cardiogenic shock at the time of hospital presentation. On average, 3.7% of these patients developed cardiogenic shock during their acute hospitalization with nonsignificant and inconsistent trends noted over time in both crude (3.7% in 2001/2003; 4.5% in 2005/2007; 2.7% in 2009/2011; P=0.19) and multivariable adjusted analyses. The overall in-hospital case-fatality rate for patients who developed cardiogenic shock was 41.4%. The crude and multivariable adjusted odds of dying after cardiogenic shock declined during the most recent study years (47.1% dying in 2001/2003, 42.0% dying in 2005/2007, and 28.6% dying in 2009/2011). Increases in the use of evidence-based cardiac medications, and interventional procedures paralleled the increasing hospital survival trends.
  
  
  CONCLUSIONS
  We found suggestions of a decline in the death, but not incidence, rates of cardiogenic shock over time. These encouraging trends in hospital survival are likely because of advances in the early recognition and aggressive management of patients who develop cardiogenic shock.
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester. Robert.Goldberg@umassmed.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
authors.forename: Raghavendra Charan P
authors.initials: RC
authors.lastname: Makam
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: From the Departments of Quantitative Health Sciences (R.J.G., R.C.P.M. J.Y., D.L.), and Medicine (D.D.M., J.M.G.), University of Massachusetts Medical School, Worcester.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: epidemiology; hospitalization; myocardial infarction; secondary prevention; shock, cardiogenic