Need for Support: Facilitating Early Transfer of Cardiogenic Shock Patients to Advanced Heart Failure Centres
Bibliographic record
Abstract
Background Cardiogenic shock (CS) is a complex, life-threatening condition that requires timely care of patients. The purpose of this study is to evaluate the characteristics and outcomes of patients transferred to a cardiac intensive-care unit from outside hospitals, compared to those of patients admitted directly to a CS centre. Methods Patients admitted with CS (January 1, 2014-December 31, 2019) were analyzed. Clinical characteristics and outcomes were recorded. Results A total of 916 patients were admitted with CS; 440 (48.0%) were transferred from outside hospitals, and 476 (52.0%) were admitted directly to our institution. Transferred patients were younger (56.5 ± 14.7 vs 63.3 ± 16.3 years, P < 0.001), required vasopressor support more often (63.6% vs 14.9%, P < 0.001), and required mechanical ventilation more often (40.6% vs 10.7%, P < 0.001) upon transfer to the cardiac intensive-care unit. Transferred patients more frequently required extracorporeal life support (8.9% vs 3.0%, P < 0.001), had a lower rate of requiring orthotopic heart transplantation (6.4% vs 14.6%, P < 0.001), and had a lower incidence of all-cause mortality during follow-up (52.3% vs 62.8%, P = 0.001). With a multivariate analysis, patients transferred from outside were found to be less likely to reach the composite endpoint of durable ventricular assist device, orthotopic heart transplantation, or death (hazard ratio 0.75, 95% confidence interval 0.62-0.90, P = 0.003). Conclusions Marked differences are present in the characteristics and outcomes of patients transferred from outside institutions vs of those transferred from within our quaternary-care centre. Further studies are required to evaluate decision-making for transfer of CS patients and assess CS outcomes in the setting of standardized CS protocols and interventions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".