Background
Cardiogenic shock (CS) is associated with poor prognosis. The use of wearable cardioverter defibrillators (WCD) in this population remains poorly investigated.
Methods
We retrospectively analyzed 730 patients treated with WCD across multiple centers, dividing them into two cohorts: 134 patients with CS and 596 without CS. Baseline characteristics, WCD data, and clinical outcomes, including mortality, rehospitalization, and device implantation, were compared between the two groups. Multivariable analysis identified predictors of mortality.
Results
Patients with CS were more likely to have a history of coronary artery disease (59% vs. 47.8%, p = 0.020), myocardial infarction (46.3% vs. 33.1%, p = 0.004), and heart failure (47.8% vs. 32.4%, p = 0.001). WCD wear duration was longer in CS patients (median 71 vs. 64 days, p = 0.003), with a higher proportion wearing the device for more than 90 days (37.6% vs. 28.6%, p = 0.042). There were no significant differences in ventricular arrhythmic events or shocks between the two groups. CS patients had higher rates of device implantation at follow-up (54.5% vs. 34.5%, p < 0.001) but no significant difference in mortality (9.7% vs. 6.4%, p = 0.172) or rehospitalization (46.6% vs. 44.3%, p = 0.692). Predictors of mortality included prior myocardial infarction (odds ratio [OR] 12.211, 95% confidence interval [CI] 1.526-97.735, p = 0.018), reduced left ventricular ejection fraction (LVEF) (OR 7.957, 95% CI 1.966-32.156, p = 0.004), and WCD wear duration (OR 0.964, 95% CI 0.942-0.987, p = 0.002).
Conclusion
Patients with CS treated with WCD exhibited higher rates of comorbidities and device implantation but had similar mortality and rehospitalization outcomes compared to those without CS. Prolonged WCD wear and improved LVEF may reduce mortality in this high-risk population.
