Frequency of Management of Cardiogenic Shock With Mechanical Circulatory Support Devices According to Race

Mechanical circulatory support (MCS) has influenced the management of cardiogenic shock (CS), but the association between race and MCS utilization is unknown. We sought to evaluate the effect of race on MCS utilization in CS and whether there are racial differences in in-hospital outcomes. Our study was a population-based retrospective cohort study that enrolled patients with CS, defined by International classification of disease, ninth Revision, clinical modification (ICD-9-CM) codes, between 2013 and 2015 from the National Inpatient Sample. Race was adjudicated by National Inpatient Sample and included White, Black, Hispanic, Asian, and Native American. The primary outcomes were the utilization of MCS devices in CS with and without acute myocardial infarction (AMI), and in-hospital mortality by race. The statistical adjustment was performed for clinical co-morbidities as well as in-hospital events using multivariate logistic regressions. Among 332,885 patients with CS, there were 71% white and 14% black patients, and AMI was present in 42% and MCS was utilized in 23% of patients. There was less utilization of MCS only in Black patients with CS, and with AMI after adjustment (odds ratio [OR] 0.84, 95% confidence interval [CI][0.79 to 0.89] and OR 0.85, 95% CI 0.78 to 0.92, respectively). In addition, only Black patients had greater in-hospital mortality in AMI after adjustment (OR 1.16, 95% CI [1.06 to 1.27]) whereas there was no statistically significant increase in in-hospital mortality in any other race. In conclusion, these results suggest that there is less utilization of MCS devices and, in parallel, increased odds of in-hospital mortality in Black patients in comparison to other races. Further steps may be needed to address possible implicit bias in acute clinical scenarios as new devices emerge, which carries new opportunities to improve clinical outcomes but there is a lack of clear guidelines.