Abstract 18332: Trends in Incidence, Management and Outcomes of Cardiogenic Shock Complicating Thyroid Storm in the United States
Introduction: Thyroid storm (TS) accounts for approximately 1-2% of admissions for thyrotoxicosis and is accompanied by profound hemodynamic derangements and development of atrial fibrillation (AF), which result in circulatory collapse and development of cardiogenic shock (CS). While the pathophysiology for this process is well described, epidemiologic and outcome data on CS secondary to TS is very limited.
Methods: We queried the National Inpatient Sample database for patients with the discharge diagnosis of thyroid storm from 2003 to 2011.
Results: We identified a total of 42,765 patients with a discharge diagnosis of TS. The overall incidence of CS was 1.1% with a gradual increase from 0.5% in 2003 to 3% in 2011(p<0.001), which was independent of race, sex and a dichotomized age of 65 years. Patients who developed CS from TS were more likely to be men (p<0.001), alcoholics (p=0.009), have pre-existing iron deficiency anemia (p <0.001), blood loss anemia (p=0.018), heart failure (p<0.001), coagulopathy (p<0.001), liver disease (p<0.001), peripheral vascular disease (p<0.001), neurological disorder (p=0.001), psychoses (p= 0006), weight loss (p<0.001), pulmonary circulatory disorder (p=0.002), electrolyte abnormalities (p<0.001), renal failure (p=0.002) and were less likely to have history of hypertension (p<0.001). Patients with CS from TS had mean hospital stay of 17.7 ± 22.8 days and in-hospital mortality of 31%. However, there was a significant mortality reduction from 60% in 2003 to 21% in 2011 (p<0.001). Approximately 44% of patients developed incident AF and 21% developed acute myocardial infarction during their hospitalization. 19.6 % of patients required mechanical circulatory support of which 88.3% received an intra-aortic balloon pump.
Conclusions: While the incidence of CS from TS has increased from 2003-2011, the mortality has steadily decreased.
Author Disclosures: D. Mohananey: None. P. Villablanca: None. N. Bhatia: None. S. Agrawal: None. J.C. Murrieta: None. M. Ganesh: None. T. Salim: None. J. Sethi: None. A. Baruah: None. M.S. Ali: None. A. Angl: None. A. Chandran: None. H. Ramakrishna: None.
- © 2016 by American Heart Association, Inc.