Abstract 4357505: Early Cardioversion in Patients with both Cardiogenic Shock and Atrial Fibrillation Is Associated with Reduced Hospital Stay but Increased Odds of Acute Myocardial Infarction and Use of Mechanical Circulatory Support

Background: Atrial fibrillation frequently complicates cardiogenic shock, yet optimal rhythm management remains unclear. Early cardioversion aims to restore sinus rhythm and improve hemodynamics, but its effect on outcomes in cardiogenic shock is not well defined. We evaluated the association between early cardioversion and clinical outcomes in patients hospitalized with concurrent atrial fibrillation and cardiogenic shock. Research Question/Hypothesis: What is the association between early cardioversion (within 2 days of hospitalization) and clinical outcomes in patients hospitalized with cardiogenic shock and atrial fibrillation?: Methods: We analyzed National Inpatient Sample data identifying adults with atrial fibrillation and cardiogenic shock using ICD-10 codes. Early cardioversion was defined as cardioversion within 2 days of admission. Survey-weighted multivariable logistic and linear regression models adjusted for demographics (age, sex, race) and hospital factors (region, teaching status, bed size) assessed associations with mortality, acute myocardial infarction, stroke, acute kidney injury, use of mechanical circulatory support, length of stay and hospital charges. Results: Among 23,703 patients with both cardiogenic shock and atrial fibrillation, 7.03% underwent early cardioversion. Compared to those without early cardioversion, these patients had shorter length of stay (mean 7.75 vs. 11.00 days, p<0.001) and lower charges (mean $195,062 vs. $251,742, p<0.001). Adjusted analyses showed no significant association with in-hospital mortality (OR 1.10, 95% CI 0.98–1.23, p=0.094). Early cardioversion was associated with higher odds of acute myocardial infarction (OR 1.16, p=0.005) and higher odds of use of mechanical circulatory support (OR 1.70, p < 0.001) but lower odds of stroke (OR 0.73, p=0.028) and acute kidney injury (OR 0.87, p=0.011). Conclusions: Early cardioversion in cardiogenic shock patients with atrial fibrillation is associated with shorter hospitalizations, lower odds of stroke and acute kidney injury but higher odds of acute myocardial infarction and use of mechanical circulatory support. This suggests there may be increased risks in cardioverting patients early in cardiogenic shock. Prospective studies are needed to optimize rhythm management and identify appropriate patients for early cardioversion to improve outcomes in this high-risk population.