Evolving trends in cardiogenic shock management in acute myocardial infarction: mortality, discharge outcomes, and economic implications

In-hospital mortality among patients with acute myocardial infarction (AMI)-related cardiogenic shock (CS) remains approximately 30-45%. While costly mechanical circulatory support (MCS) devices were expected to improve prognosis, previous studies have demonstrated limited benefits. This retrospective study aimed to evaluate contemporary mortality, discharge rates to home, and associated medical costs in patients with AMI-related CS, using the Japanese nationwide administrative dataset, JROAD-DPC, between 2012 and 2023. Of 75,619 patients with AMI-related CS, in-hospital mortality occurred in 33,869 (45%). Among 41,750 survivors, 9850 (24%) were not discharged home. Costs for all patients averaged 15,500 USD, with 26,300 USD for survivors treated with MCS, 13,600 USD for survivors without, 19,700 USD for non-survivors treated with MCS, and 1200 USD for non-survivors without. Among survivors treated with MCS, costs were 24,100 USD for those discharged home and 34,700 USD for those not discharged home. After its approval in 2018, the use of microaxial flow pump increased and in-hospital mortality decreased from 46.2% in 2018 to 43.3% in 2022 (p < 0.001). However, during the study period, the proportion of patients not discharged home increased from 10.5 to 14.0% (p < 0.001) and medical costs rose from 13,900 USD to 15,600 USD. (p < 0.001). Over the decade, in-hospital mortality of AMI-related CS decreased slightly, while healthcare costs increased, particularly for patients treated with MCS who either died or were not discharged home. These findings warranted future studies to optimize MCS use and construct effective treatment strategies to improve prognosis and minimize potentially avoidable spending.