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Research Snapshot Theater: Cardiovascular/Shock, Adult II

Outcomes and Predictors of Mortality in ED Patients With SCAI C Heart Failure Cardiogenic Shock

Sunday, March 22, 2026
9:45 AM - 10:45 AM Central Time
Location: Connections Central - RST 03

  • Ruixi Zhang, PharmD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • SK

    Scott Ketcham, MD

    Pulmonary and Critical Care medicine Fellow
    University of Michigan Health

    Disclosure information not submitted.

  • MK

    Matthew Kennedy, DO

    Clinical Assistant Professor of Emergency Medicine
    University of Michigan Health

    Disclosure information not submitted.

  • AS

    Adam Stein, MD

    Clinical Assistant Profession of Cardiovascular Medicine
    University of Michigan Health

    Disclosure information not submitted.

  • RP

    Raymond Pashun, MD

    Clinical Assistant Professor of Cardiovascular and Critical Care Medicine
    University of Michigan health

    Disclosure information not submitted.

  • SA

    Sarah Adie, PharmD, BCCP

    Clinical Pharmacist Cardiology
    University of Michigan Health

    Disclosure information not submitted.

Introduction: Cardiogenic shock (CS) is a complex, high-mortality disease state. Timely recognition and optimal management are essential to improve outcomes. The 2025 American College of Cardiology clinical guidance suggests that patients with SCAI C heart failure CS (HF-CS) should be admitted to the CICU within 60 minutes of initial evaluation; however, there is no literature on the trajectory or outcomes for patients with HF-SCAI C in the emergency department (ED) or if achieving CICU transfer time improves outcomes. The goal of this study is to evaluate mortality differences during hospital admission in patients presenting with SCAI C HF-CS and identify factors associated with mortality.


Methods: This retrospective cohort study included patients diagnosed with SCAI C HF-CS in the ED from 7/1/2023-5/31/2025. Cohorts were analyzed on hospital death. A multivariate logistic regression was performed to assess the relationship between hospital death with explanatory variables of gender, age, admission service, and initial lactate.


Results: A total of 208 patients were included with 53 (25.5%) who died during hospital admission. Compared to survivors, patients with in-hospital mortality were older (70.9±15.9 years vs 64.3±17 years; p< 0.01), were more likely to be admitted to the CICU (62.3% vs 34.8%; p< 0.01), and had a higher initial lactate (5.18 ± 3.01 mmol/L vs 3.67 ± 2.18 mmol/L). There was no difference in time to CICU transfer between patients who did and did not die. In multivariate analysis, age (OR=1.03, [1.01; 1.06], p< 0.01), initial lactate (OR=1.21, [1.04; 1.4], p= 0.014), and female gender (OR=2.53, [1.22; 5.26], p= 0.013) were associated with higher rates of hospital death. Admission service (OR=0.24, [0.05 ; 1.13], p= 0.0711) was not associated with hospital death after adjustment.


Conclusions: Older age, higher initial lactate, and female gender were associated with increased mortality among patients presenting to the ED with SCAI C HF-CS. There was no significant difference in time to CICU transfer and a large proportion of patients never received care in the CICU. Future studies should identify which patients with SCAI C HF-CS would be appropriately managed on the floor and determine if transfer to the CICU within one hour is required for all patients with CS.