https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; 3Klinikum Sankt Georg Klinik für Kardiologie, Angiologie und intern. Intensivmedizin Leipzig, Deutschland; 4HELIOS Klinikum Krefeld Medizinische Klinik I Krefeld, Deutschland; 5Universitätsklinikum Münster Klinik für Kardiologie II - Rhythmologie Münster, Deutschland; 6Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 7Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 8Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil gGmbH Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 9Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland
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.