Trends reveal growing burden of deaths from non-ischemic cardiogenic shock

New data from the CDC WONDER database finds deaths from heart attack-related cardiogenic shock (CS) decreased between 1999 and 2020, but deaths linked to heart failure (HF) and abnormal heart rhythms have risen sharply since 2010, particularly among men. Researchers presented the findings today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d'intervention (CAIC-ACCI) Summit in Montreal.

Each year, more than 50,000 Americans experience CS, a critical, life-threatening condition that occurs when the heart dysfunctions, reducing blood flow and oxygen delivery to critical tissues and organs. Ischemic CS is characterized by a sudden, massive failure of the heart, most often after an acute myocardial infarction (AMI) or heart attack. Non-ischemic CS is typically triggered by genetics, muscle weakness, infections, or inflammation, often due to congestive HF or arrhythmia (also known as an abnormal heart rhythm). Historically, CS research has primarily focused on ischemia, since ischemic injury causes over 80% of CS cases.

Using the CDC's WONDER database (1999–2020), researchers stratified AMI, HF, and arrhythmia data to evaluate CS mortality trends in adults aged 25 and above. Clinicians calculated age-adjusted mortality rates (AAMR) per 100,000 patients, annual percentage changes (APC), and average annual percentage changes (AAPC) using Join Point regression analysis.

The study found that deaths from heart attack-related CS declined from 1990 to 2020 (AAPC -1.95), with females experiencing a significantly greater reduction compared to males (AAPC –2.72 vs. -1.72). Conversely, CS deaths stemming from HF increased overall (AAPC +5.12), with a 25% greater growth in males versus females (AAPC +5.71 vs. +4.56). Arrhythmia-related deaths also rose significantly from 1999 to 2020 (AAPC +4.45), with men having a 26.7% greater increase compared to females (AAPC +4.93 vs. +3.89). From 2010 to 2020, CS deaths related to heart attack stabilized, while HF and arrhythmia-related deaths spiked dramatically (APC +14.30, +12.33).

Despite a steady decline in heart attack-related CS deaths, non-ischemic CS mortality has risen sharply in the United States in the last 15 years, which should be cause for concern. While our results suggest health systems have successfully improved care for ischemic CS, non-ischemic CS remains an under-recognized public health challenge. Policy initiatives supporting regional shock systems, improved access to advanced mechanical support, and targeted trials for non-ischemic cardiogenic shock are urgently needed."

Yasitha Kakarlapudi, MD, DHR Health in Edinburg, Texas