Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).
E, H.D., L, S.J., M, P.S., Jeong-Gun, P., E, M.Z., R, M.M., K, A.S., L, A.C., F, B.C., D, B.D., E, B.C., A, B.E., P, C.A., B, D.L., W, D.M., Ann, G., Umesh, G., Michael, G., N, K.J., . . . D, T.A. (2026). Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).. Circ Heart Fail. https://doi.org/10.1161/CIRCHEARTFAILURE.125.013778
E HD, L SJ, M PS, Jeong-Gun P, E MZ, R MM, et al. Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).. Circ Heart Fail. 2026; doi: 10.1161/CIRCHEARTFAILURE.125.013778
E HD, L SJ, M PS, et al. Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).[J]. Circ Heart Fail. 2026. DOI: 10.1161/CIRCHEARTFAILURE.125.013778.
@article{e2026,
author = {Hamilton David E and Shriver Jackson L and Patel Siddharth M and Park Jeong-Gun and Michos Zoe E and Mathis Michael R and Adie Sarah K and Alviar Carlos L and Barnett Christopher F and Berg David D and Bennett Courtney E and Bohula Erin A and Carnicelli Anthony P and Daniels Lori B and Dodson Mark W and Gage Ann and Gidwani Umesh and Goldfarb Michael and Katz Jason N and Ketcham Scott W and Kwon Younghoon and Leibner Evan S and Loriaux Daniel B and Luk Adriana and Marano Paul and Miller P Elliott and Mukundan Srini V and Papolos Alexander I and Pisani Barbara A and Proudfoot Alastair G and Roswell Robert O and Shah Kevin S and Solomon Michael A and Tomey Matthew I and van Diepen Sean and Zakaria Sammy and Morrow David A and Thompson Andrea D},
title = {Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN).},
journal = {Circ Heart Fail},
year = {2026},
doi = {10.1161/CIRCHEARTFAILURE.125.013778},
note = {PMID: 42093634},
}
TY - JOUR AU - Hamilton David E AU - Shriver Jackson L AU - Patel Siddharth M AU - Park Jeong-Gun AU - Michos Zoe E AU - Mathis Michael R AU - Adie Sarah K AU - Alviar Carlos L AU - Barnett Christopher F AU - Berg David D AU - Bennett Courtney E AU - Bohula Erin A AU - Carnicelli Anthony P AU - Daniels Lori B AU - Dodson Mark W AU - Gage Ann AU - Gidwani Umesh AU - Goldfarb Michael AU - Katz Jason N AU - Ketcham Scott W AU - Kwon Younghoon AU - Leibner Evan S AU - Loriaux Daniel B AU - Luk Adriana AU - Marano Paul AU - Miller P Elliott AU - Mukundan Srini V AU - Papolos Alexander I AU - Pisani Barbara A AU - Proudfoot Alastair G AU - Roswell Robert O AU - Shah Kevin S AU - Solomon Michael A AU - Tomey Matthew I AU - van Diepen Sean AU - Zakaria Sammy AU - Morrow David A AU - Thompson Andrea D TI - Variation in Vasoactive Treatment Selection for Cardiogenic Shock: Insights From the Critical Care Cardiology Trials Network (CCCTN). T2 - Circ Heart Fail PY - 2026 DO - 10.1161/CIRCHEARTFAILURE.125.013778 AN - PMID:42093634 ER -
The paucity of data to guide selection of specific vasoactive agents in patients with cardiogenic shock (CS) may lead to variability in practice patterns. The level of variability and specific factors that are associated with the use of vasoactive medications and inodilators have not been previously described. The CCCTN (Critical Care Cardiology Trials Network) is an international, multicenter network of cardiac intensive care units (CICUs) coordinated by the TIMI Study Group. This analysis included CICU admissions for CS from 2019 to 2023. Variation in the use of inodilator treatment (dobutamine/milrinone) was assessed with multivariable mixed-effects logistic modeling. A total of 3282 admissions from 37 CICUs comprised the analysis cohort. The use of vasoactive medications, including inodilator treatment, varied substantially across institutions. Patient-level variables associated with greater use of inodilators included history of heart failure (odds ratio, 1.98 [95% CI, 1.61-2.44]), biventricular failure (1.59 [95% CI, 1.27-2.00]), Society of Cardiovascular Angiography and Interventions stage D (1.34 [95% CI, 1.07-1.68]), valvular disease (1.34 [95% CI, 1.03-1.74]), and male sex (1.23 [95% CI, 1.02-1.49]). Variables associated with less inodilator use included cardiac arrest (0.33 [95% CI, 0.27-0.42]), right ventricular failure (0.50 [95% CI, 0.33-0.73]), Society of Cardiovascular Angiography and Interventions stage E (0.57 [95% CI, 0.41-0.81]), acute myocardial infarction-CS (0.71 [95% CI, 0.56-0.90]), peripheral arterial disease (0.73 [95% CI, 0.54-0.99]), older age (0.77 [95% CI, 0.72-0.83], per 10-year increase), and estimated glomerular filtration rate (0.96 [95% CI, 0.93-0.99], per 10 mL/min per 1.73 m2 increase). No individual measurable institution-level factors (eg, transplant center) were associated with variability in inodilator use. In mixed-effects logistic modeling, 45.7% of variation in inodilator use was attributed to patient-level factors and 22.7% to the random effect of individual CICU centers. Similarly, 35.3% of variation in the use of dobutamine versus milrinone was attributed to patient-level factors and 32.6% to the random effect of individual CICU centers. There is significant variation in vasoactive treatment and inodilator use in CS. Variation in inodilator use was associated with patient-level factors and with substantial individual CICU practice variation. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.