Socioeconomic Status and Equity among patients with Cardiogenic Shock.

Marta Marcos-Mangas¹Teresa Lopez-Sobrino²Albert Ariza Solé^3,4*Ferran Rueda-Sobella¹Esther Sanz-Girgas⁵Jaime Aboal⁶Pablo Pastor⁷Irene Buera⁸Alessandro Sionis⁹Rut Andrea²Judit Rodriguez-López⁵Carlos Tomás⁷Jordi Bañeras⁸Isaac Llaó⁴Jose C Sánchez-Salado⁴Cosme Garcia Garcia¹

• ¹Hospital Germans Trias i Pujol, Badalona, Spain
• ²Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
• ³Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
• ⁴Bellvitge University Hospital, Barcelona, Balearic Islands, Spain
• ⁵Joan XXIII University Hospital of Tarragona, Tarragona, Catalonia, Spain
• ⁶Doctor Josep Trueta Girona University Hospital, Girona, Catalonia, Spain
• ⁷University Hospital Arnau de Vilanova, Lleida, Catalonia, Spain
• ⁸Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
• ⁹Sant Pau Institute for Biomedical Research, Barcelona, Catalonia, Spain

Background: We aimed to analyze the impact of socioeconomic status (SES) on management and inhospital outcomes of patients with cardiogenic shock (CS).Methods: This was a prospective observational registry conducted (December 2018 -November 2019) in Intensive Cardiac Care Units (ICCU) across 8 tertiary care centers. Consecutive patients aged ≥18 years with a primary diagnosis of cardiogenic shock were included. SES was defined using a numerical index that incorporates mean income levels, premature mortality, and avoidable hospitalizations observed within a specific health area. SES values were categorized into tertiles. Inhospital procedures, complications, length of stay, and in-hospital mortality were collected.Results: A total of 382 patients were included (mean age: 65.3 years). There were no differences in age, sex, or major comorbidities across SES groups. CS was more frequently due to acute coronary syndrome (ACS) in patients with low SES (66.9% vs. 58%, p=0.022). No significant differences were observed regarding SCAI stage or other severity markers of CS across SES groups. Patients with low SES were more likely to receive pulmonary artery catheterization (p=0.029) and mechanical circulatory support (p=0.038). After adjusting for potential confounders, clinical management was similar regardless SES. Lower SES patients exhibited a higher incidence of bleeding (p=0.018). There were no differences in length of stay or in-hospital mortality among SES groups.Conclusions: Beyond a higher rate of ACS-related CS, patients with low SES exhibited a clinical profile and shock severity comparable to other SES groups. Therapeutic management aligned with guideline recommendations even in patients with low SES.