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Background: Cardiogenic shock (CS) continues to be associated with substantial in-hospital mortality. Variations in staffing levels, resource availability and clinical workflows during night-time or weekend ("off-hours") periods may affect early management. However, the independent impact of off-hours admission on outcomes after adjustment for disease severity remains unclear.

Purpose: To assess whether admission during night-time or weekends is independently associated with in-hospital mortality among patients with cardiogenic shock.

Methods: We conducted a retrospective single-centre cohort study including all consecutive patients admitted with CS between 2018 and 2022. The primary outcome was in-hospital mortality. Variables associated with mortality in univariate analysis (p<0.10), the exposure of interest (off-hours admission), and clinically relevant covariates were entered into a multivariable logistic regression model. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were reported.

Results: The study included 175 patients, with a mean age of 66 years; 47 (26.9%) were women. Acute coronary syndrome (ACS) was the presenting diagnosis in 112 patients (64%), and 47 (26.9%) were classified as Society for Cardiovascular Angiography and Interventions (SCAI) stage D/E. Moderate-to-severe left ventricular systolic dysfunction was present in 133 patients (76%). Overall in-hospital mortality was 32.0% (n=56). In univariate analysis, advanced shock severity (SCAI D/E; p=0.004), ACS versus non-ACS presentation (p=0.016), and off-hours admission (p=0.021) were associated with mortality. The multivariable model included age, sex, SCAI stage, ACS versus non-ACS diagnosis, and off-hours admission. After adjustment, only advanced shock severity remained independently associated with mortality (SCAI D/E vs A–C: aOR 2.82; 95% CI 1.29–6.15; p=0.007). Off-hours admission showed a non-significant trend toward increased mortality (aOR 1.79; 95% CI 0.87–3.70; p=0.092).

Conclusion: Although admission during nights or weekends was associated with higher unadjusted mortality, this association did not persist after adjustment for clinical severity. Advanced cardiogenic shock stage was the sole independent predictor of in-hospital mortality. Larger, multicentre studies are warranted to further explore the potential influence of organisational factors during off-hours on outcomes in cardiogenic shock.

Impact of off-hours admission on in-hospital mortality in patients with cardiogenic shock

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Doctor Francisco Lemos De Sousa

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ePosters in acute cardiac care - cardiogenic shock (2)

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Heart Failure 2026

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