Early Cardioversion in Patients with both Cardiogenic Shock and Atrial Fibrillation Is Associated with Reduced Hospital Stay but Increased Odds of Acute Myocardial Infarction and Use of Mechanical Circulatory Support AHA Conference Repository

American Heart Association

101

Final ID: MP273

Early Cardioversion in Patients with both Cardiogenic Shock and Atrial Fibrillation Is Associated with Reduced Hospital Stay but Increased Odds of Acute Myocardial Infarction and Use of Mechanical Circulatory Support

Abstract Body (Do not enter title and authors here): Background:
Atrial fibrillation frequently complicates cardiogenic shock, yet optimal rhythm management remains unclear. Early cardioversion aims to restore sinus rhythm and improve hemodynamics, but its effect on outcomes in cardiogenic shock is not well defined. We evaluated the association between early cardioversion and clinical outcomes in patients hospitalized with concurrent atrial fibrillation and cardiogenic shock.
Research Question/Hypothesis:
What is the association between early cardioversion (within 2 days of hospitalization) and clinical outcomes in patients hospitalized with cardiogenic shock and atrial fibrillation?
Methods:
We analyzed National Inpatient Sample data identifying adults with atrial fibrillation and cardiogenic shock using ICD-10 codes. Early cardioversion was defined as cardioversion within 2 days of admission. Survey-weighted multivariable logistic and linear regression models adjusted for demographics (age, sex, race) and hospital factors (region, teaching status, bed size) assessed associations with mortality, acute myocardial infarction, stroke, acute kidney injury, use of mechanical circulatory support, length of stay and hospital charges.
Results:
Among 23,703 patients with both cardiogenic shock and atrial fibrillation, 7.03% underwent early cardioversion. Compared to those without early cardioversion, these patients had shorter length of stay (mean 7.75 vs. 11.00 days, p<0.001) and lower charges (mean $195,062 vs. $251,742, p<0.001). Adjusted analyses showed no significant association with in-hospital mortality (OR 1.10, 95% CI 0.98–1.23, p=0.094). Early cardioversion was associated with higher odds of acute myocardial infarction (OR 1.16, p=0.005) and higher odds of use of mechanical circulatory support (OR 1.70, p < 0.001) but lower odds of stroke (OR 0.73, p=0.028) and acute kidney injury (OR 0.87, p=0.011).
Conclusions:
Early cardioversion in cardiogenic shock patients with atrial fibrillation is associated with shorter hospitalizations, lower odds of stroke and acute kidney injury but higher odds of acute myocardial infarction and use of mechanical circulatory support. This suggests there may be increased risks in cardioverting patients early in cardiogenic shock. Prospective studies are needed to optimize rhythm management and identify appropriate patients for early cardioversion to improve outcomes in this high-risk population.

Tsyngauz, Esther ( Mount Sinai Morningside West , New York , New York , United States )
Bonilla, Harrison ( Mount Sinai Morningside West , New York , New York , United States )
Guardia, Joshua ( Mount Sinai Morningside West , New York , New York , United States )

Author Disclosures:

Esther Tsyngauz:

DO NOT have relevant financial relationships

Harrison Bonilla:

No Answer

Joshua Guardia:

No Answer

Meeting Info:

Scientific Sessions 2025

2025

New Orleans, Louisiana

Session Info:

Cardiogenic Shock Across Systems and Populations: Trends, Disparities, and Innovations in Care Delivery and Outcomes

Saturday, 11/08/2025 , 12:15PM - 01:10PM

Moderated Digital Poster Session

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ANCA-Negative Eosinophilic Myocarditis Masquerading as STEMI: A Case of Fulminant Cardiogenic Shock

Bonilla Harrison, Guardia Joshua, Niroula Shailesh, Liranzo Niurka, Tsyngauz Esther

Outcomes Associated with GLP1 Receptor Agonist Use in Hypertrophic Cardiomyopathy

Berman Brandon, Bonilla Harrison, Guardia Joshua, Tsyngauz Esther

American Heart Association