Digital Out-of-hospital Management on Clinical Outcomes in Patients With Early Cardiogenic Shock

Prior treatment

• The reasons for discharge were treatment withdrawal and transfer to another hospital for continued therapy
• Previous or current hospital admission due to cardiac arrest

Other illness

• Refractory Heart Failure (ACC/AHA guidelines Stage D heart Failure)
• Severe hepatic insufficiency (Child-Pugh class C)
• Severe chronic obstructive pulmonary disease (confirmed by pulmonary function tests, or requiring long-term home oxygen therapy or long-term use of corticosteroids)
• History of cardiac surgery
• Combined with malignant tumors and other serious diseases, the expected life span is less than 1 year
• Neuropsychiatric disorders, unable to cooperate with management;

Lab values

• Left ventricular ejection fraction \< 30%

Other

• Unable to use a smartphone for out-of-hospital management despite training
• Refractory cardiogenic shock
• (Estimated) glomerular filtration rate \< 25 ml/min or on dialysis
• Pregnant or lactating women
• Participation in other clinical trials within the past year;
• Other circumstances considered to be inappropriate for this study by the investigator.

• Age ≥ 18 years old;
• The patient meets the diagnosis of early-stage cardiogenic shock, with SCAI stage A, B, or C during hospitalization; (1) SCAI stage A:
  • Without signs of shock and meeting one of the following criteria:
• Combined with extensive myocardial infarction, diagnosed as widespread anterior wall myocardial infarction based on ST-segment elevation in ECG leads (V1-V5, aVL, I leads), inferior wall combined with right ventricular (II, III, aVF, V3R-V5R leads) and/or posterior wall myocardial infarction (V7-V9 leads), or recurrent myocardial infarction within 28 days.
• Concurrent acute heart failure or acute exacerbation of chronic heart failure. (2) SCAI stage B-C (meeting the following conditions)
  • 1\) 60 \< SBP \< 90 mmHg or mean arterial blood pressure 50 \< MAP \< 60 mmHg or a decrease of \> 30 mmHg from baseline lasting 30 minutes; or SBP ≥ 90 mmHg but heart rate /SBP \> 1 lasting \> 30 minutes.
  • 2\) The highest arterial blood lactate during hospitalization \< 5 mmol/L. 3. Stable clinical symptoms at discharge, defined as:
• SBP ≥ 90 mmHg when vasoactive drugs are not used;
• No signs and symptoms of shock. 4. Understand and be willing to sign the informed consent, and be willing to follow the treatment and visit plan required by the protocol.