{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:35:35Z","timestamp":1792726535168,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,1,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Cardiogenic shock (\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              ) is associated with significant morbidity, and mortality rates approach 40% to 60%. Treatment for\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              requires an aggressive, sophisticated, complex, goal\u2010oriented, therapeutic regimen focused on early revascularization and adjunctive supportive therapies, suggesting that hospitals with greater\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              volume may provide better care. The association between\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              hospital volume and inpatient mortality for\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              is unclear.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We used the Nationwide Inpatient Sample to examine 533\u00a0179 weighted patient discharges from 2675 hospitals with\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              from 2004 to 2011 and divided them into quartiles of mean annual hospital\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              case volume. The primary outcome was in\u2010hospital mortality. Multivariate adjustments were performed to account for severity of illness, relevant comorbidities, hospital characteristics, and differences in treatment. Compared with the highest volume quartile, the adjusted odds ratio for inpatient mortality for persons admitted to hospitals in the lowest\u2010volume quartile (\u226427 weighted cases per year) was 1.27 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.15 to 1.40), whereas for admission to hospitals in the low\u2010volume and medium\u2010volume quartiles, the odds ratios were 1.20 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.08 to 1.32) and 1.12 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.01 to 1.24), respectively. Similarly, improved survival was observed across quartiles, with an adjusted inpatient mortality incidence of 41.97% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              40.87 to 43.08) for hospitals with the lowest volume of\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              cases and a drop to 37.01% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              35.11 to 38.96) for hospitals with the highest volume of\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              cases. Analysis of treatments offered between hospital quartiles revealed that the centers with volumes in the highest quartile demonstrated significantly higher numbers of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, or intra\u2010aortic balloon pump counterpulsation. A similar relationship was demonstrated with the use of mechanical circulatory support (ventricular assist devices and extracorporeal membrane oxygenation), for which there was significantly higher use in the higher volume quartiles.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We demonstrated an association between lower\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              case volume and higher mortality. There is more frequent use of both standard supportive and revascularization techniques at the higher volume centers. Future directions may include examining whether early stabilization and transfer improve outcomes of patients with\n              <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n              who are admitted to lower volume centers.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.114.001462","type":"journal-article","created":{"date-parts":[[2015,1,6]],"date-time":"2015-01-06T02:43:20Z","timestamp":1420512200000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":171,"title":["Effect of Cardiogenic Shock Hospital Volume on Mortality in Patients With Cardiogenic Shock"],"prefix":"10.1161","volume":"4","author":[{"given":"Shahzad","family":"Shaefi","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"O'Gara","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robb D.","family":"Kociol","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Joynt","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Nizamuddin","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eitezaz","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Talmor","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajid","family":"Shahul","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 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