Abstract
AIMS: Mortality for cardiogenic shock (CS) remains high. To improve outcomes, centralization of treatment in specialized centres, especially those with expertise in mechanical circulatory support (MCS), has been recommended. High-volume centres may be able to provide standardized, better care. We analysed associations between centre volume and outcomes in Germany, a large country with multiple types of CS centres. METHODS AND RESULTS: Based on data from all CS patients treated in Germany from 2017-2021, the association between annual CS/MCS hospital volume and in-hospital mortality was assessed using adjusted Cox-regression, and spline plots were used to assess case thresholds. Overall, 220 223 CS patients underwent treatment at 1232 hospitals; 435/1232 (35%) of these performed MCS therapy, although only few hospitals (60/435, 14%) performed >25 MCS cases per year on average. Treatment at hospitals with a higher annual volume of CS and MCS cases was associated with a significantly lower mortality risk as compared to hospitals with a lower volume (upper third vs. lower two-thirds; CS: hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.91-0.94; p < 0.001; MCS: HR 0.80, 95% CI 0.76-0.84; p < 0.001). These associations were continuous without a detectable ceiling effect, with spline plots suggesting case thresholds of at least 90 CS cases/25 MCS cases per year. CONCLUSIONS: Care for patients with CS treated with and without MCS is associated with lower in-hospital mortality in hospitals that manage high volumes of CS and MCS. This analysis indicates that centralization of CS care in specialized centres treating high volumes of patients with CS and MCS might improve outcomes.